Ertuğrul Özgür Zülfükar, Karaaslan Fırat, Yılmaz Reşit, Tuncer Mehmet Cudi
Gazi Yaşargil Training and Research Hospital, Department of Radiology, University of Health Sciences, Diyarbakır 21090, Turkey.
Gazi Yaşargil Training and Research Hospital, Department of Neurology, University of Health Sciences, Diyarbakır 21090, Turkey.
Brain Sci. 2025 Jun 30;15(7):704. doi: 10.3390/brainsci15070704.
BACKGROUND/OBJECTIVES: Nutritional status is increasingly acknowledged as a pivotal determinant of clinical course and recovery in patients with acute ischemic stroke (AIS). Malnutrition can compromise immune competence, delay neurological recovery, and exacerbate adverse outcomes, particularly in those undergoing intensive interventions such as mechanical thrombectomy (MT). To objectively assess nutritional status, indices such as the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) score have been utilized in various clinical populations. These indices incorporate routinely available laboratory parameters, reflecting both nutritional and inflammatory states. This study explores whether PNI and CONUT scores are associated with 90-day clinical outcomes in AIS patients treated with MT, aiming to evaluate their potential utility as prognostic biomarkers in acute stroke care.
A total of 404 patients with AIS who underwent MT between 2023 and 2024 were retrospectively evaluated. Demographic, clinical, and laboratory data were collected, and nutritional status was assessed using PNI and CONUT scores. Clinical outcomes were stratified as favorable (modified Rankin Scale [mRS] 0-2) or unfavorable (mRS 3-6) at 90 days post-stroke.
Among the 404 patients included in the study, 50.5% had favorable and 49.5% had unfavorable clinical outcomes. Patients with favorable outcomes were younger (71 vs. 78 years, = 0.001), had lower National Institutes of Health Stroke Scale (NIHSS) scores, and higher Alberta Stroke Program Early CT Scores (ASPECTS) ( = 0.001). The puncture-to-recanalization time was significantly longer in the unfavorable outcome group (47.5 min vs. 30.0 min, = 0.003). Laboratory findings revealed higher glucose levels ( = 0.029), and lower serum albumin ( = 0.003) and lymphocyte levels ( = 0.001) in the unfavorable outcome group. Among nutritional indices, the CONUT score was significantly higher in the unfavorable outcome group ( = 0.001), whereas the PNI score was higher in the favorable outcome group ( = 0.001). ROC analysis showed that the CONUT score had significant prognostic performance (AUC = 0.721, < 0.001), while the PNI had poor discriminatory power (AUC = 0.274, < 0.001). Multivariate logistic regression identified age, baseline NIHSS, ASPECT score, and CONUT score as independent predictors of clinical outcome ( < 0.05).
Among the two nutritional indices evaluated, the CONUT score demonstrated significant prognostic value in predicting 90-day clinical outcomes after MT. In contrast, the PNI showed limited discriminatory power, highlighting the superiority of CONUT as a reliable biomarker in acute stroke care.
背景/目的：营养状况日益被认为是急性缺血性脑卒中（AIS）患者临床病程和康复的关键决定因素。营养不良会损害免疫能力、延迟神经功能恢复并加重不良后果，尤其是在接受机械取栓术（MT）等强化干预的患者中。为了客观评估营养状况，预后营养指数（PNI）和控制营养状况（CONUT）评分等指标已在各种临床人群中得到应用。这些指标纳入了常规可得的实验室参数，反映了营养和炎症状态。本研究探讨PNI和CONUT评分是否与接受MT治疗的AIS患者90天临床结局相关，旨在评估它们作为急性卒中护理中预后生物标志物的潜在效用。
对2023年至2024年间接受MT治疗的404例AIS患者进行回顾性评估。收集人口统计学、临床和实验室数据，并使用PNI和CONUT评分评估营养状况。临床结局在卒中后90天分层为良好（改良Rankin量表[mRS] 0 - 2）或不良（mRS 3 - 6）。
在纳入研究的404例患者中，50.5%临床结局良好，49.5%临床结局不良。结局良好的患者更年轻（71岁对78岁，P = 0.001），美国国立卫生研究院卒中量表（NIHSS）评分更低，阿尔伯塔卒中项目早期CT评分（ASPECTS）更高（P = 0.001）。不良结局组的穿刺至再通时间明显更长（47.5分钟对30.0分钟，P = 0.003）。实验室检查结果显示，不良结局组血糖水平更高（P = 0.029），血清白蛋白更低（P = 0.003），淋巴细胞水平更低（P = 0.001）。在营养指标中，不良结局组的CONUT评分明显更高（P = 0.001），而良好结局组的PNI评分更高（P = 0.001）。ROC分析表明，CONUT评分具有显著的预后性能（AUC = 0.721，P < 0.001），而PNI的鉴别能力较差（AUC = 0.274，P < 0.001）。多因素逻辑回归确定年龄、基线NIHSS、ASPECT评分和CONUT评分是临床结局的独立预测因素（P < 0.05）。
在评估的两个营养指标中，CONUT评分在预测MT后90天临床结局方面显示出显著的预后价值。相比之下，PNI的鉴别能力有限，突出了CONUT作为急性卒中护理中可靠生物标志物的优越性。
