Nutritional status and risk of hemorrhagic transformation in acute ischemic stroke patients treated with mechanical thrombectomy

Abstract

This study aimed to investigate the association between nutritional status and hemorrhagic transformation (HT) after mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS). We retrospectively analyzed registry data from the Affiliated Hospital of Xuzhou Medical University collected between November 2018 and May 2023. Nutritional status was assessed using the prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI). Patients were classified according to the presence or absence of HT on follow-up computed tomography performed 24–36 h after MT. Propensity-score matching (PSM) was based on admission National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT Score, and successful recanalization. Separate multivariable logistic regression models for PNI and GNRI additionally adjusted for eosinophil count and thrombin time to address residual confounding after matching. Receiver operating characteristic (ROC) curve analyses assessed discrimination for HT. A total of 236 patients were included, among whom 45 patients developed HT. After PSM and multivariable adjustment, higher PNI (odds ratio [OR] per unit increase, 0.831; 95% confidence interval [CI], 0.762–0.907; P < 0.001) and higher GNRI (OR per unit increase, 0.935; 95% CI, 0.895–0.977; P = 0.003) were associated with lower odds of HT. The areas under the receiver operating characteristic (ROC) curve were 0.768 for PNI (95% CI, 0.678–0.857) and 0.693 for GNRI (95% CI, 0.590–0.796). Lower nutritional indices were associated with HT after MT in this retrospective cohort. These findings support PNI and GNRI as potential risk-stratification markers but do not establish causality. Larger prospective studies with external validation are required.