Comparative prognostic value of inflammatory and nutritional indices in acute ischemic stroke: a multivariable model analysis

Aims: Given that acute ischemic stroke (AIS) is a leading cause of mortality and long-term disability, the early identification of reliable prognostic markers is essential. This study evaluates the prognostic value of composite inflammatory and nutritional indices, including the monocyte-to-high-density lipoprotein cholesterol ratio (MHR), Systemic Immune-Inflammation Index (SII), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) score, in predicting intensive care unit (ICU) admission and one-year mortality following AIS. Methods: This single-center retrospective cohort study included 496 patients with a confirmed diagnosis of AIS. Clinical characteristics, laboratory parameters, and outcomes were retrospectively retrieved. The prognostic significance of selected inflammatory indices [MHR, SII, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR)] and nutritional indices (PNI and CONUT) was analyzed using univariate and multivariate logistic regression models, along with receiver operating characteristic (ROC) curve analysis. Results: Higher SII and CONUT scores and lower PNI values were significantly associated with both ICU admission and one-year mortality. In multivariate analysis, CONUT and MHR emerged as independent predictors of one-year mortality, while PNI, CONUT, and MHR independently predicted ICU admission. Among all indices evaluated, CONUT demonstrated the highest predictive accuracy for both outcomes. Conclusion: In patients with AIS, composite inflammatory and nutritional indices-particularly CONUT and MHR-provided valuable prognostic information. These markers, derived from routine laboratory tests, offer a practical and cost-effective method for early risk stratification and may help guide more personalized care pathways in stroke management.