Impact of Prognostic Nutrition Index and Neutrophil/Lymphocyte Ratio on Outcomes in Acute Ischemic Stroke

Abstract

Background This study aims to investigate the impact of the prognostic nutrition index and neutrophil-lymphocyte ratio on survival and neurological outcomes in acute ischemic stroke patients at risk of malnutrition who are monitored in Intensive Care Units. Materials and Methods This retrospective study analysed 215 patients with their first ischemic stroke admitted to the Neurology Intensive Care Unit. The prognostic nutritional index was derived from serum albumin and complete blood count within the first 24 hours using this formula: PNI = (serum albumin level [g/dL] × 10) + (total lymphocyte count [mm³] × 0.005) The prognostic nutritional index was categorised into two groups according to a cut-off value of 42.5 determined by ROC analysis. Results During the 60-day follow-up, multivariable logistic regression analysis of neurological prognosis identified the presence of coronary artery disease (Hazard Ratio [HR]: 3.9, p: 0.021), initial NIHSS score (HR: 1.16, p <0.001), and PNI (HR: 0.022, p <0.001) as independent predictors of neurological outcomes. Cox regression analysis for survival in all patients determined age (HR: 1.93, p = 0.009), initial NIHSS score (HR: 1.04, p = 0.008), BUN level (HR: 1.69, p = 0.012), and prognostic nutritional index (HR: 0.27, p = 0.007) as independent determinants of mortality. Conclusion Our findings suggest that simple, cost-effective, and readily applicable biomarkers such as the prognostic nutritional index and the neutrophil-lymphocyte ratio should be considered practical tools in patient management and predicting neurological outcomes.