Association Between PNI and All-Cause Mortality in Ischemic Stroke Patients: A Large-Scale Retrospective Cohort Study

Why It Matters

The study highlights a simple, inexpensive biomarker that can stratify stroke patients’ survival risk, guiding nutritional interventions and resource allocation in acute care settings.

Key Takeaways

• Higher PNI reduces stroke mortality risk.
• Each 1-unit PNI increase cuts risk 8.5%.
• Top PNI quartile shows 72.6% lower mortality.
• PNI AUC ~0.71 predicts all-cause death.
• Findings robust across subgroups and sensitivities.

Pulse Analysis

Ischemic stroke remains a leading cause of disability and death worldwide, prompting clinicians to seek readily available tools that can forecast outcomes beyond traditional imaging and clinical scores. The prognostic nutritional index, which combines serum albumin and lymphocyte count, reflects both nutritional status and systemic inflammation—two factors intimately linked to post‑stroke recovery. By leveraging a single‑center cohort of over a thousand patients, researchers demonstrated that even modest improvements in PNI translate into measurable survival benefits, underscoring the index’s relevance in a population where malnutrition is often under‑diagnosed.

The analysis employed multivariate Cox regression, adjusting for age, comorbidities, and stroke severity, revealing a hazard ratio of 0.915 per unit increase in PNI and a striking 0.274 hazard ratio for patients in the top quartile. Subgroup and sensitivity checks confirmed the consistency of these findings across gender and varying PNI cut‑offs. Moreover, the ROC curve’s area under the curve of 0.71 indicates that PNI offers moderate discriminative power, rivaling more complex prognostic models while requiring only routine laboratory data. Such performance positions PNI as a pragmatic addition to existing risk stratification frameworks.

For health systems, integrating PNI into discharge planning could trigger early nutritional support, potentially curbing mortality and readmission rates. Future research should explore whether targeted dietary or immunomodulatory interventions can further amplify the survival advantage associated with higher PNI scores. As precision medicine evolves, the simplicity and cost‑effectiveness of PNI make it an attractive candidate for large‑scale implementation in stroke units across diverse care settings.