Background: The controlling nutritional status (CONUT) score and the prognostic nutritional index (PNI) score were designed as indicators of patients’ immune-nutritional status. This study aimed to investigate the prognostic impact of the CONUT and PNI scores on long-term recurrent ischemic stroke (RIS) and adverse outcomes for adults with acute ischemic stroke (AIS). Methods: This retrospective study enrolled 991 AIS patients. Multivariable Cox regression models were used to assess the relationships of the malnutritional indices and RIS and major cardiovascular events (MACEs). Results: During a median follow-up at 44 months (IQR 39–49 months), 203 (19.2%) patients had RIS and 261 (26.3%) had MACEs. Compared with normal nutritional status, moderate to severe malnutrition was significantly related to an increased risk of RIS in the CONUT score (adjusted hazard ratio (HR) 3.472, 95% confidence interval (CI) 2.223–5.432, p < 0.001). A higher PNI value tertile (tertile two, adjusted HR 0.295, 95% CI 0.202–0.430; tertile three, adjusted HR 0.445, 95% CI 0.308–0.632, all p < 0.001) was related to a lower risk of RIS. Similar results were found for MACEs. The PNI exhibited nonlinear association with the RIS and both two malnutritional indices improved the model’s discrimination when added to the model with other clinical risk factors. Conclusions: This study demonstrated that the CONUT and PNI are promising, straightforward screening indicators to identify AIS patients with impaired immune-nutritional status at higher risk of long-term RIS and MACEs.

Background: Matrix metalloproteinase-9 (MMP-9) and brain-derived neurotrophic factor (BDNF) have documented roles in the inflammatory injury cascade of neurovascular units following ischemic brain injury. However, their dynamic changes and predictive values after acute ischemic stroke (AIS) have not been well elucidated.Objective: To investigate the temporal profiles of serum MMP-9 and BDNF concentrations and their relationship with the prognosis in patients with AIS.Methods: MMP-9 and BDNF levels were measured in 42 AIS patients in prospectively collected blood samples, which were taken on the first day (Day 1), the second day (Day 2), and the fifth day (Day 5) after admission. Healthy subjects (n = 40) were used as controls. The AIS patients were divided into groups of good functional prognosis (n = 24) and poor prognosis (n = 18) according to their modified Rankin Scale score at 3 months. Longitudinal analysis of MMP-9 and BDNF and their association with neurological prognosis was performed using repeated measurement ANOVA.Results: At baseline (Day 1), the levels of serum MMP-9 and BDNF were significantly higher in the AIS group than in the normal control group (P < 0.01). Repeated measurement ANOVA showed a significant main effect and interaction of MMP-9 between good prognosis and the poor group (P < 0.05). Further simple-effect analysis showed that the MMP-9 level was significantly increased in the poor prognosis group compared with the good prognosis group at T5 (P < 0.05). There were no significant time-dependent or the interaction effect (all P > 0.05), but a main effect (P < 0.05) for BDNF. Compared with the poor prognosis group, the simple-effect results indicated that the BDNF level of the good prognosis group was lower at Day 1, while the same was reversed for expression at Day 5 (P < 0.05).Conclusion: MMP-9 and BDNF are closely related to the prognosis of patients with AIS in a time-dependent manner. The dynamic changes of the two biomarkers are superior to baseline levels in predicting the prognosis of AIS patients. A sustained decrease in MMP-9 and an increase in BDNF levels in AIS patients after several days of treatment implied a favourable prognosis.

Background: The malnutrition and inflammatory status are dependently associated with an increased risk of poor prognosis in patients with acute ischemic stroke (AIS). However, the evidence surrounding the prognostic significance of albumin-based malnutritional indices in AIS patients receiving reperfusion therapy remains insufficient. We aimed to explore prognostic value of the controlling nutritional status score (CONUT), prognostic nutritional index score (PNI), and neutrophil percentage-to-albumin ratio (NPAR) on short-term outcome of AIS patients undergoing reperfusion therapy.Methods: A total of 612 AIS patients were enrolled. The association of the malnutritional indices and 3-months poor prognosis was accessed by multivariable logistics regression model. We further performed a logistic regression model with restricted cubic splines to examine the potential nonlinear correlations between the malnutritional indices and short-term poor prognosis. Subgroup analysis and reclassification indexes were also conducted to enhance the robustness of the findings. Additionally, mediation analyses were performed to examined the potential mediating effects of early neurological deterioration (END) presence on the associations of malnutrition with 3-months unfavorable outcomes.Results: 256 patients developed poor prognosis at 3-month follow-up. Malnutrition was associated with the risk of 3-month poor functional outcome for CONUT (per 1-point increased, adjusted OR 1.59, 95%CI 1.40–1.82), for PNI (per 1-point increased, adjusted OR 0.86, 95%CI 0.82–0.90), and the NPAR (per 1-SD increased, adjusted OR 23.97, 95%CI 7.15–85.72). The PNI exhibited nonlinear association with the 3-month poor prognosis. These three indices in addition to other clinical risk factors improved the model discrimination. Compared to the NPAR, the net reclassification improvement of PNI (0.579, 95%CI 0.418–0.739) and CONUT (0.631, 95%CI 0.470–0.792) were higher in predicting short-term poor prognosis. The findings were further supported by subgroup analyses, and END had no significant mediated effects on the associations of malnutrition and 3-month unfavorable outcome.Conclusion: Albumin-based malnutritional indices are reliable and feasible prognostic indicators in AIS patients, predicting short-term outcome independent of the type of reperfusion treatment. The applicability of these objective malnutritional indices may improve risk stratification and guide nutritional interventions at clinical setting in this vulnerable ischemic stroke population.