The impact of nutritional and inflammatory status on mortality in stroke patients: Results from NHANES 2005-2018.

BACKGROUND

Stroke significantly impacts global health, being a primary cause of disability, dementia, and mortality. The interplay of nutritional deficiency and systemic inflammation plays a pivotal role in determining stroke outcomes. While the Prognostic Nutritional Index (PNI) and the Advanced Lung Cancer Inflammation Index (ALI) have been recognized for their prognostic value in various diseases, their relevance in stroke prognosis necessitates further exploration.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018, analyzing 908 stroke survivors to examine the associations between PNI, ALI, and mortality outcomes. Weighted Cox proportional hazards models were applied to assess the associations, controlling for demographic and health-related variables. Kaplan-Meier curves and restricted cubic splines were used to evaluate survival differences and non-linear relationships, respectively. Additionally, subgroup and sensitivity analyses were conducted to verify the robustness of the associations.

RESULTS

In our cohort, elevated PNI was associated with significantly lower risks of all-cause mortality (Hazard Ratio [HR]: 0.53, 95 % Confidence Interval [CI]: 0.37-0.75, p < 0.001) and cardiovascular mortality (HR: 0.60, 95 % CI: 0.38-0.94, p = 0.028). Similarly, higher ALI levels correlated with a reduced risk of all-cause mortality (HR: 0.53, 95 % CI: 0.37-0.72, p < 0.001), though its impact on cardiovascular mortality did not reach statistical significance after adjustment. Subgroup analysis revealed that gender, age, and diabetes status modulated the relationship between PNI/ALI and mortality outcomes, with significant interactions observed especially in diabetic patients (PNI: P for interaction = 0.025 and ALI: P for interaction = 0.007).

CONCLUSIONS

This study confirms that higher PNI and ALI are associated with lower all-cause mortality in stroke survivors. Elevated PNI also reduces cardiovascular mortality risk. Gender, age, and diabetes status influence these associations. These findings highlight the importance of monitoring nutritional and inflammatory status in stroke recovery.