Fatty Acid Ratios Versus Conventional Risk Factors in Stroke: Insights into Severe Disability and Mortality Outcomes

Objective: This study aims to investigate the role of fatty acid ratios, specifically DHA/ARA and EPA/ARA, in predicting severe disability and mortality in stroke patients and compare these ratios with conventional risk factors such as age, sex, hypertension, diabetes, and dyslipidemia. Methods: A prospective study was conducted involving 298 consecutive acute ischemic stroke patients (within 72 h of onset). Fatty acid ratios were measured from plasma, and all patients’ evolution was followed through hospitalization. Binary logistic regression analysis was used to identify predictors of severe disability at discharge (Rankin 4–6) and in-hospital mortality, including fatty acid ratios and conventional risk factors. Results: A higher DHA/ARA ratio was associated with a reduced chance of severe disability (OR = 0.81), while a higher EPA/ARA ratio was associated with an increased chance of severe disability (OR = 1.70). Age was a significant factor, with older age (median 70 years) associated with a lower survivability chance (OR = 0.93) and a higher likelihood of severe disability when surviving. Fatty acid ratios did not significantly affect mortality outcomes. For male patients, EPA/AA ratios showed a powerful association with severe disability (p = 0.045), while no significant effect of fatty acids was observed in females. Conclusions: Fatty acids were significant predictors of severe disability in patients with acute ischemic stroke, independent of conventional risk factors, but without having any effect on in-hospital mortality. Age remained the only significant conventional risk factor predictor of outcome. Integrating fatty acid ratios alongside conventional risk factors may improve predictions of severe post-stroke disability, potentially guiding more personalized interventions for stroke patients.