Baseline nutritional risk predicts 90-day outcome after mechanical thrombectomy

Background and aims: Malnutrition affects up to 30-50% of patients with acute ischemic stroke and is independently associated with infectious complications, worse functional recovery, and increased mortality; yet its prognostic impact in the specific setting of mechanical thrombectomy (MT) for large-vessel occlusion (LVO) remains poorly characterized.We aimed to determine whether baseline nutritional status, assessed by the Controlling Nutritional Status (CONUT) score, independently predicts 90-day functional outcome and mortality after MT.Methods: A retrospective cohort of 385 consecutive patients with acute ischemic stroke due to large-vessel occlusion was analysed.The patients were treated with mechanical thrombectomy.The initial nutritional status of the participants was evaluated using the CONUT score, which was analysed both as a continuous variable and according to conventional severity categories.The primary outcomes were poor functional outcome at 90 days (modified Rankin Scale [mRS] 3-6) and 90-day all-cause mortality.Univariable and multivariable logistic regression models were fitted, and model performance was assessed by discrimination and calibration metrics.Results: Patients were distributed across CONUT categories as follows: normal 96 (21%), mild 169 (37%), moderate 99 (21%), and severe 21 (5%).Higher CONUT categories were associated with progressively worse 90-day mRS distributions.In multivariable analyses, higher CONUT score remained independently associated with poor functional outcome (adjusted odds ratio [OR] 1.195 per point; 95% confidence interval [CI] 1.048-1.363;p = 0.008) and with 90-day mortality (adjusted OR 1.258; 95% CI 1.113-1.420;p < 0.001).Model discrimination was good for poor functional outcome (AUC 0.846; 95% CI 0.798-0.894)and moderate for mortality (AUC 0.758; 95% CI 0.689-0.827).Inclusion of CONUT score improved risk stratification and clinical net benefit beyond a clinical-radiological base model.Conclusions: In this real-world MT cohort, higher baseline CONUT was independently associated with greater 90-day disability and mortality after adjustment for established clinical, imaging, and procedural factors.Routine CONUT assessment at admission may enhance risk stratification, facilitate early nutritional consultation, and inform post-acute care planning in MT candidates.Whether targeted nutritional interventions can improve outcomes in patients with high CONUT scores warrants prospective evaluation.