Associations of Inflammation-Related Nutritional and Metabolic Status Indices CAR and CTI with 90-Day Unfavorable Functional Outcomes in Patients with Acute Ischemic Stroke

Why It Matters

These inexpensive, routinely available blood‑based indices enhance early risk stratification after stroke, potentially guiding treatment intensity and rehabilitation planning. Incorporating CAR and CTI into prognostic models could improve outcome prediction beyond traditional clinical factors.

Key Takeaways

• CAR and CTI predict 90‑day stroke outcomes.
• Higher CAR (OR 1.25) and CTI (OR 1.38) increase risk.
• CTI shows linear risk; CAR non‑linear with breakpoint.
• Six‑variable model (sex, age, BMI, NIHSS, CAR, CTI) AUC 0.837.
• Internal validation stable; external validation required before use.

Pulse Analysis

Inflammation and metabolic dysregulation are increasingly recognized as key drivers of secondary brain injury after acute ischemic stroke. Traditional prognostic tools rely on age, stroke severity scores, and imaging, but they overlook systemic physiological stress that can be captured through simple laboratory tests. The C‑reactive protein‑to‑albumin ratio (CAR) merges an acute‑phase reactant with a marker of nutritional reserve, while the CRP‑triglyceride‑glucose index (CTI) extends this concept to include lipid and glucose metabolism, offering a multidimensional view of a patient’s inflammatory‑metabolic state.

In the Korean cohort, both CAR and CTI independently predicted 90‑day unfavorable functional outcomes, with odds ratios of 1.25 and 1.38 per standard‑deviation increase, respectively. CTI’s relationship with risk was essentially linear, whereas CAR exhibited a threshold effect, suggesting that very high inflammatory burden may disproportionately worsen prognosis. When evaluated as single predictors, CAR and CTI achieved area‑under‑the‑curve values around 0.65, outperforming their individual components such as albumin or fasting glucose. Integrating these indices into a six‑variable model that also includes sex, age, body‑mass index and admission NIHSS boosted discrimination to an AUC of 0.837, and internal cross‑validation confirmed stable calibration and Brier scores.

The findings highlight the potential of CAR and CTI to augment early stroke risk assessment without adding cost or complexity, as the required labs are routinely ordered on admission. However, the model remains exploratory; external validation across diverse populations and care settings is essential before clinical adoption. Future research should explore dynamic changes in these indices, their interaction with reperfusion therapies, and whether targeted interventions based on elevated CAR or CTI can improve functional recovery.