Akut iskemik inmede inflamatuvar ve nütrisyonel indekslerin karşılaştırmalı prognostik değeri: çok değişkenli model analizi

Abstract

Amaç: Önemli bir mortalite ve uzun süreli özürlülük nedeni olan akut iskemik inmede (Aİİ), güvenilir prognostik belirteçlerin erken dönemde saptanması büyük önem taşımaktadır. Bu çalışmada, inflamatuvar ve nütrisyonel bileşik indekslerin – monosit/HDL kolesterol oranı (MHR), sistemik immün-inflamasyon indeksi (SII), prognostik nütrisyonel indeks (PNI) ve beslenme durumu kontrolü skoru (CONUT) – Aİİ sonrası yoğun bakım (YBÜ) yatışı ve bir yıllık mortaliteyi öngörmedeki değeri değerlendirilmiştir. Yöntemler: Tek merkezli, retrospektif kohort olarak planlanan bu çalışmaya Aİİ tanısı almış 496 hasta dahil edilmiştir. Klinik ve laboratuvar verileri ile klinik sonuçlar hasta dosyalarından elde edilmiştir. Seçilen inflamatuvar (MHR, SII, NLR, MLR, PLR) ve nütrisyonel (PNI, CONUT) indekslerin prognostik değeri, tek değişkenli/çok değişkenli lojistik regresyon ve ROC eğrisi analizleri ile değerlendirilmiştir. Bulgular: SII, PNI ve CONUT skorlarının hem YBÜ yatışı hem de bir yıllık mortalite ile anlamlı ilişkili olduğu bulunmuştur. Çok değişkenli analizde ise, MHR ile birlikte CONUT skoru bir yıllık mortalitenin bağımsız bir yordayıcısı olarak belirlenmiştir. PNI, CONUT ve MHR, YBÜ yatışını öngörmede etkili bulunmuştur. Her iki sonlanım açısından CONUT skoru en yüksek prediktif doğruluğu göstermiştir. Sonuç: Akut iskemik inme hastalarında CONUT ve MHR başta olmak üzere, bazı inflamatuvar ve nütrisyonel bileşik indeksler prognostik değer taşımaktadır. Basit laboratuvar testleri ile elde edilebilen bu belirteçler, erken dönemde etkili risk sınıflandırmasına olanak tanıyarak maliyet duyarlı sağlık sistemlerinde kişiselleştirilmiş inme yönetimi yollarını destekleyebilir.

Keywords

• akut iskemik inme
• CONUT skoru
• prognostik model
• inflamatuvar biyobelirteçler
• nütrisyonel değerlendirme

Comparative prognostic value of inflammatory and nutritional indices in acute ischemic stroke: a multivariable model analysis

Abstract

Aims: Given that acute ischemic stroke (AIS) is a leading cause of mortality and long-term disability, the early identification of reliable prognostic markers is essential. This study evaluates the prognostic value of composite inflammatory and nutritional indices, including the monocyte-to-high-density lipoprotein cholesterol ratio (MHR), Systemic Immune-Inflammation Index (SII), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) score, in predicting intensive care unit (ICU) admission and one-year mortality following AIS. Methods: This single-center retrospective cohort study included 496 patients with a confirmed diagnosis of AIS. Clinical characteristics, laboratory parameters, and outcomes were retrospectively retrieved. The prognostic significance of selected inflammatory indices [MHR, SII, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR)] and nutritional indices (PNI and CONUT) was analyzed using univariate and multivariate logistic regression models, along with receiver operating characteristic (ROC) curve analysis. Results: Higher SII and CONUT scores and lower PNI values were significantly associated with both ICU admission and one-year mortality. In multivariate analysis, CONUT and MHR emerged as independent predictors of one-year mortality, while PNI, CONUT, and MHR independently predicted ICU admission. Among all indices evaluated, CONUT demonstrated the highest predictive accuracy for both outcomes. Conclusion: In patients with AIS, composite inflammatory and nutritional indices-particularly CONUT and MHR-provided valuable prognostic information. These markers, derived from routine laboratory tests, offer a practical and cost-effective method for early risk stratification and may help guide more personalized care pathways in stroke management.

Keywords

• Acute ischemic stroke
• CONUT score
• prognostic model
• inflammatory biomarkers
• nutritional assessment

Ethical Statement

This study was initiated following the approval of the Ethics Committee of the University of Health Sciences Sancaktepe Prof. Dr. İlhan Varank Training and Research Hospital (approval number: 2023/257, dated 19.12.2023).

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