Gao Weiwei, Yu Lingfeng, Zhang Yifen, Jin Shouyue, Chen Zhongjie, Chen Xingyu, Cai Lijuan, Zhu Renjing
Department of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Xiamen Clinical Research Center for Cerebrovascular Diseases, Xiamen, China.
Front Nutr. 2025 Jun 18;12:1504208. doi: 10.3389/fnut.2025.1504208. eCollection 2025.
To investigate the associations between three nutritional indices-Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) score, and Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score-and 90-day functional outcomes in patients with large vessel occlusion acute ischemic stroke (LVO-AIS) who underwent endovascular therapy (EVT).
In this retrospective cohort study, we consecutively enrolled 409 LVO-AIS patients who received EVT at a comprehensive stroke center between January 2019 and December 2024. The primary endpoint was poor functional outcome, defined as a modified Rankin Scale (mRS) score of 3-6 at 90 days. Associations between nutritional indices and functional outcomes were analyzed using multivariable logistic regression models with stepwise adjustment. Restricted cubic spline (RCS) analysis was performed to explore potential non-linear relationships. Subgroup analyses with interaction tests assessed the consistency of these associations across demographic and clinical subgroups.
At 90-day follow-up, 261 patients (63.8%) had poor functional outcomes. The prevalence of malnutrition risk varied substantially between nutritional indices: PNI identified 15.9% of patients at risk, whereas the CONUT scoring system classified 81.9% of patients as having some degree of malnutrition risk. After comprehensive adjustment for confounders, each one-unit increase in PNI was associated with a 6% reduction in the risk of poor outcomes (adjusted OR = 0.94, 95% CI: 0.89-0.99, = 0.026), while each one-unit increase in HALP score was associated with a 3% reduction (adjusted OR = 0.97, 95% CI: 0.96-0.99, = 0.001). RCS analysis revealed a significant non-linear relationship between HALP score and functional outcomes (-non-linear = 0.021), characterized by a steep risk reduction as scores increased at lower values, followed by a plateau effect. Subgroup analyses demonstrated consistent associations between nutritional indices and outcomes across various demographic and clinical characteristics, with no significant interaction effects observed.
Prognostic Nutritional Index and HALP scores serve as independent predictors of poor 90-day functional outcomes in LVO-AIS patients treated with EVT. The significant non-linear relationship observed between HALP score and functional outcomes suggests that interventions targeting patients with moderate to severe malnutrition risk may yield greater clinical benefits.
探讨三种营养指标——预后营养指数（PNI）、控制营养状况（CONUT）评分和血红蛋白-白蛋白-淋巴细胞-血小板（HALP）评分——与接受血管内治疗（EVT）的大血管闭塞急性缺血性卒中（LVO-AIS）患者90天功能结局之间的关联。
在这项回顾性队列研究中，我们连续纳入了2019年1月至2024年12月期间在一家综合卒中中心接受EVT的409例LVO-AIS患者。主要终点是功能结局不良，定义为90天时改良Rankin量表（mRS）评分为3-6分。使用逐步调整的多变量逻辑回归模型分析营养指标与功能结局之间的关联。进行限制立方样条（RCS）分析以探索潜在的非线性关系。通过交互检验进行亚组分析，以评估这些关联在不同人口统计学和临床亚组中的一致性。
在90天随访时，261例患者（63.8%）功能结局不良。营养指标之间营养不良风险的患病率差异很大：PNI识别出15.9%的患者有风险，而CONUT评分系统将81.9%的患者分类为有一定程度的营养不良风险。在对混杂因素进行全面调整后，PNI每增加一个单位，不良结局风险降低6%（调整后的OR = 0.94，95% CI：0.89-0.99， = 0.026），而HALP评分每增加一个单位，风险降低3%（调整后的OR = 0.97，95% CI：0.96-0.99， = 0.001）。RCS分析显示HALP评分与功能结局之间存在显著的非线性关系（-非线性 = 0.021），其特征是在较低值时随着评分增加风险急剧降低，随后出现平台效应。亚组分析表明，营养指标与结局之间在各种人口统计学和临床特征方面存在一致的关联，未观察到显著的交互作用。
预后营养指数和HALP评分是接受EVT治疗的LVO-AIS患者90天功能结局不良的独立预测因素。HALP评分与功能结局之间观察到的显著非线性关系表明，针对中度至重度营养不良风险患者的干预措施可能会产生更大的临床益处。
