Application of Prognostic Nutritional Index in predicting the prognosis of Acute Ischemic Stroke patients

Abstract

Introduction: Stroke is a leading cause of mortality and disability worldwide, with ischemic stroke accounting for 70% of cases. Malnutrition is a common complication, increasing susceptibility to infections and worsening outcomes. The Prognostic Nutritional Index (PNI), based on serum albumin and lymphocyte count, is a promising tool for assessing nutritional and inflammatory status in stroke patients. This study evaluates the prognostic utility of PNI in acute ischemic stroke (AIS) patients. Methods: A hospital-based cross-sectional study was conducted at Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, over 12 months. Eighty-two AIS patients meeting the inclusion criteria were enrolled. PNI was calculated as [(10 × serum albumin) + (0.005 × total lymphocyte count)]. Logistic regression and ROC curve analysis assessed PNI's predictive value for clinical outcomes. Results: The mean age of participants was 60.5 ± 11.8 years, with a male predominance (65.9%). Low PNI was significantly associated with unfavourable clinical outcomes (OR: 0.797, 95% CI: 0.68-0.935, p = 0.005). ROC analysis demonstrated good predictive accuracy (AUC = 0.816, p < 0.001), with a PNI cut-off of 46.165 (sensitivity: 84.21%, specificity: 66.67%). Discussion: Lower PNI correlated with increased stroke severity, infection risk, and mortality, consistent with prior studies. However, variations in PNI cut-off values across studies suggest further validation is needed. Conclusion: PNI is a valuable prognostic tool in AIS, aiding in early risk stratification and guiding nutritional interventions. Future longitudinal studies are needed to confirm its clinical applicability