Journal Article

Impact of Prognostic Nutritional Index and Neutrophil-to-Lymphocyte Ratio on Clinical Outcomes of Acute Ischemic Stroke/Prognostik Nutrisyonel Indeksi ve Notrofil-Lenfosit Oraninin Akut Iskemik Inmenin Klinik Sonlanimina Etkisi

Cakirgoz, Mensure, Sevil, Hatice, Tiryaki, Enise Nur Ozlem, Tanriverdi, Zeynep, Duztas, Dilan, Mingsar, Eren

2025

Overview

Objectives: Acute ischemic stroke (AIS) is a significant cause of death and disability worldwide. Inflammation affects brain damage and prognosis in ischemic stroke, while malnutrition significantly impacts clinical outcomes. The prognostic nutritional index (PNI) and neutrophil-to-lymphocyte ratio (NLR) are used to assess nutritional and inflammatory status, respectively. The aim of our study was to determine the role of PNI and NLR in predicting the prognosis of ischemic stroke. Methods: A total of 215 acute ischemic stroke patients hospitalized in our neurology intensive care unit between September 2020 and November 2021 were retrospectively analyzed. Stroke classifications, vascular risk factors, laboratory parameters, and mortality rates of acute ischemic stroke cases were evaluated. PNI and NLR were calculated, and PNI values were dichotomized into two groups using a cutoff point of 42.5, determined via receiver operating characteristic (ROC) analysis. Results: Over a 60-day period, a multivariable logistic regression analysis for neurological prognosis revealed that coronary artery disease (hazard ratio [HR]:3.9, p=0.021), initial National Institutes of Health Stroke Scale (NIHSS) score (HR:1.16, p<0.001), and PNI (HR:0.022, p<0.001) were significant independent predictors of neurological outcomes. Additionally, Cox regression analysis for overall patient survival indicated that age (HR:1.93, p=0.009), initial NIHSS score (HR:1.04, p=0.008), blood urea nitrogen (BUN) level (HR:1.69, p=0.012), and PNI (HR:0.27, p=0.007) were independent factors influencing mortality. Conclusion: PNI and NLR are accessible and cost-effective biomarkers. These indicators provide insights into patients' inflammatory and nutritional profiles, enabling clinicians to make informed treatment decisions and serving as predictors of prognosis in AIS patients. Keywords: Acute ischemic stroke; Neutrophil-to-lymphocyte ratio; Prognostic nutritional index. Amac: Akut iskemik inme (AII), dunya genelinde onemli bir olum ve sakatlik nedenidir. Inflamasyon, iskemik inmede beyin hasarini ve prognozu etkilerken; malnutrisyon da klinik sonlanimi onemli olcude etkilemektedir. Prognostik nutrisyonel indeks (PNI) ve notrofil-lenfosit orani (NLR), sirasiyla beslenme durumu ve inflamatuvar yaniti degerlendirmek amaciyla kullanilmaktadir. Bu calismanin amaci, PNI ve NLR'nin iskemik inme prognozunu belirlemedeki yerini ortaya koymaktir. Yontem: Eylul 2020 ile Kasim 2021 tarihleri arasinda noroloji yogun bakim unitemizde izlenen toplam 215 akut iskemik inme hastasi retrospektif olarak analiz edilmistir. Hastalarin etyolojik siniflamalari, vaskuler risk faktorleri, laboratuvar parametreleri ve mortalite oranlari degerlendirilmistir. PNI ve NLR degerleri hesaplanmis, ROC analizi ile belirlenen 42,5 kesme degeri esas alinarak PNI iki gruba ayrilmistir. Bulgular: Altmis gunluk izlem sonunda yapilan cok degiskenli lojistik regresyon analizinde, koroner arter hastaligi (Risk Orani [HR]:3,9; p=0,021), giris Ulusal Saglik Enstitusu Inme Olcegi (NIHSS) skoru (HR:1,16; p<0,001) ve PNI (HR:0,022; p<0,001) norolojik sonuclarin anlamli bagimsiz belirleyicileri olarak bulunmustur. Ayrica, genel sagkalimi degerlendiren Cox regresyon analizinde yas (HR:1,93; p=0,009), giris NIHSS skoru (HR:1,04; p = 0,008), kan ure azotu (BUN) seviyesi (HR:1,69; p=0,012) ve PNI (HR:0,27; p=0,007) mortaliteyi etkileyen bagimsiz faktorler olarak saptanmistir. Sonuc: PNI ve NLR, kolay ulasilabilir ve dusuk maliyetli biyobelirteclerdir. Bu belirtecler, hastalarin inflamatuvar ve beslenme profilleri hakkinda bilgi saglayarak klinik karar sureclerini desteklemekte ve AII prognozunun ongorulmesinde kullanilabilmektedir. Akut iskemik inme; Notrofil-lenfosit orani; Prognostik nutrisyonel indeks.

• Publisher: KARE Publishing