Table 1_Nonlinear dose–response relationship between prognostic nutritional index and short-term outcome in acute ischemic stroke: a prospective cohort study.docx

ObjectiveThe evidence surrounding the connection between the Prognostic Nutritional Index (PNI) and the prognosis of patients with Acute Ischemic Stroke (AIS) remains insufficient. Therefore, this study is designed to examine how PNI relates to short-term outcomes in individuals affected by AIS.
MethodsThis study is a single-center, prospective cohort investigation. The study sample comprised 1,697 patients with AIS who received treatment at Shenzhen Second People’s Hospital between January 2022 and June 2024. To evaluate the association between the PNI and the risk of at 90-day unfavorable outcomes, as well as 90-day mortality, a binary logistic regression model was employed. Furthermore, a logistic regression model incorporating cubic spline functions was utilized to explore the potential non-linear relationship between PNI and 90-day unfavorable outcomes. Additionally, a series of sensitivity analyses and subgroup analyses were performed to enhance the robustness of the findings.
ResultsFollowing the adjustment for covariates, the binary logistic regression analysis demonstrated a notable inverse connection between PNI and the occurrence of unfavorable outcomes at 90 days among patients diagnosed with AIS (OR = 0.951, 95% CI: 0.925–0.979). A similarly significant negative relationship was found between PNI and 90-day mortality (OR = 0.868, 95% CI: 0.806–0.934). Additionally, the study revealed a non-linear association between PNI and 90-day, identifying an inflection point at PNI = 49.3. To the left of this inflection point, the OR for the risk of 90-day unfavorable outcomes in AIS patients was 0.910 (95% CI: 0.880–0.942). Conversely, to the right of the inflection point, the OR was 1.149 (95% CI: 0.998–1.249), although this finding was not statistically significant. The findings were further supported by sensitivity analyses, which reinforced the reliability of these results.
ConclusionThis study reveals a significant negative association between the PNI and 90-day unfavorable outcomes as well as 90-day mortality in patients with AIS. A non-linear relationship between PNI and 90-day unfavorable outcomes was observed. Specifically, a significant inverse association between them was evident when PNI values were below 49.3. These findings offer valuable insights for refining rehabilitation strategies and improving the clinical management of AIS patients.

目前关于预后营养指数（Prognostic Nutritional Index, PNI）与急性缺血性脑卒中（Acute Ischemic Stroke, AIS）患者预后关联的相关证据仍较为匮乏。因此，本研究旨在探讨PNI与急性缺血性脑卒中患者短期预后的关联情况。
本研究为单中心前瞻性队列研究。研究样本纳入2022年1月至2024年6月期间于深圳市第二人民医院接受治疗的1697例急性缺血性脑卒中患者。为评估PNI与90天不良结局风险及90天死亡率的关联，本研究采用二元logistic回归模型。此外，本研究还运用纳入三次样条函数的logistic回归模型，以探究PNI与90天不良结局间潜在的非线性关联。同时，本研究开展了一系列敏感性分析与亚组分析，以提升研究结果的稳健性。
在校正协变量后，二元logistic回归分析结果显示，急性缺血性脑卒中患者的PNI水平与90天不良结局的发生呈显著负相关（OR=0.951，95%CI：0.925–0.979）。PNI与90天死亡率同样存在显著负相关关系（OR=0.868，95%CI：0.806–0.934）。此外，本研究发现PNI与90天不良结局间存在非线性关联，其拐点为PNI=49.3。在该拐点左侧，急性缺血性脑卒中患者90天不良结局风险的比值比为0.910（95%CI：0.880–0.942）；而在拐点右侧，该比值比为1.149（95%CI：0.998–1.249），但此结果未达到统计学显著性。敏感性分析进一步验证了本研究结果的可靠性。
本研究结果表明，急性缺血性脑卒中患者的PNI水平与90天不良结局及90天死亡率均呈显著负相关，且PNI与90天不良结局间存在非线性关联。具体而言，当PNI水平低于49.3时，二者间存在显著负相关关系。本研究结果为优化急性缺血性脑卒中患者的康复策略与临床管理方案提供了重要参考依据。