Objective Nutritional Indices as an Independent Predictor of Functional Outcome After Endovascular Therapy for Acute Ischemic Stroke: A Cohort Study in a Chinese Population

Weiwei Gao¹Lingfeng Yu¹Yifen Zhang²Shouyue Jin¹Zhongjie Chen^1,2Xingyu Chen¹Lijuan Cai^1*Renjing Zhu^1*

• ¹Zhongshan Hospital, Xiamen University, Xiamen, China
• ²School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, China

Objective: 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).Methods: 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.Results: 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, P=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, P=0.001). RCS analysis revealed a significant non-linear relationship between HALP score and functional outcomes (P-nonlinear=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.Conclusion: PNI 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.