A prognostic inflammation-nutrition reserve index for 180-day functional-survival outcomes after acute ischemic stroke in patients aged 80 years or older
- 1Department of Neurology, Jiujiang First People's Hospital
Abstract
Background: Patients aged 80 years or older with acute ischemic stroke (AIS) have heterogeneous functional-survival outcomes despite similar clinical severity. We evaluated whether a routine laboratory-derived Prognostic Inflammation-Nutrition Reserve Index (PINRI) was associated with the 180-day ordinal functional survival state.
Methods: This single-center cohort study screened consecutive patients admitted with suspected AIS from January 2021 through December 2024. Admission PINRI combined an internally standardized logarithmic C-reactive protein-to-albumin ratio, the logarithmic systemic inflammatory response index, and the inverse of the prognostic nutritional index; no transportable clinical threshold was proposed. The primary outcome was 180-day modified Rankin Scale (mRS) 0–2, mRS 3–5, or death.
Results: Among 278 analyzable patients, 111 (39.9%) achieved mRS 0–2, 114 (41.0%) had mRS 3–5, and 53 (19.1%) died; 167 (60.1%) experienced dependency or death. Each 1-SD increase in admission PINRI was associated with a worse functional survival state after adjusting for selected clinical covariates (adjusted common odds ratio [aOR], 1.98; 95% CI, 1.48–2.65; p < 0.001). The aOR for the highest versus lowest tertile was 3.43 (95% CI, 1.74–6.74; p < 0.001). The first-week PINRI burden remained associated with a worse outcome among 241 day-7 landmark survivors (aOR, 1.80; 95% CI, 1.19–2.72; p = 0.005). Adding PINRI improved the internally optimism-corrected C-statistic for dependency/death from 0.810 to 0.834 (difference, 0.024; p = 0.033). Comparator single-marker C-statistics were 0.821–0.825; none differed significantly from PINRI after false discovery rate (FDR) control.
Conclusion: Higher admission PINRI and first-week PINRI burden were associated with a worse 180-day functional survival state and provided modest incremental information beyond the clinical model. Multicenter validation and local calibration are required before implementation.
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BibTeX
@article{zhang2026prognostic,
title = {{A prognostic inflammation-nutrition reserve index for 180-day functional-survival outcomes after acute ischemic stroke in patients aged 80 years or older}},
author = {Lianhong Zhang and Jinghua Peng},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1910335},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1910335/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - A prognostic inflammation-nutrition reserve index for 180-day functional-survival outcomes after acute ischemic stroke in patients aged 80 years or older
AU - Lianhong Zhang
AU - Jinghua Peng
PY - 2026
DA - 2026/10/23
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1910335
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1910335/full
AB - Background: Patients aged 80 years or older with acute ischemic stroke (AIS) have heterogeneous functional-survival outcomes despite similar clinical severity. We evaluated whether a routine laboratory-derived Prognostic Inflammation-Nutrition Reserve Index (PINRI) was associated with the 180-day ordinal functional survival state. Methods: This single-center cohort study screened consecutive patients admitted with suspected AIS from January 2021 through December 2024. Admission PINRI combined an internally standardized logarithmic C-reactive protein-to-albumin ratio, the logarithmic systemic inflammatory response index, and the inverse of the prognostic nutritional index; no transportable clinical threshold was proposed. The primary outcome was 180-day modified Rankin Scale (mRS) 0–2, mRS 3–5, or death. Results: Among 278 analyzable patients, 111 (39.9%) achieved mRS 0–2, 114 (41.0%) had mRS 3–5, and 53 (19.1%) died; 167 (60.1%) experienced dependency or death. Each 1-SD increase in admission PINRI was associated with a worse functional survival state after adjusting for selected clinical covariates (adjusted common odds ratio [aOR], 1.98; 95% CI, 1.48–2.65; p < 0.001). The aOR for the highest versus lowest tertile was 3.43 (95% CI, 1.74–6.74; p < 0.001). The first-week PINRI burden remained associated with a worse outcome among 241 day-7 landmark survivors (aOR, 1.80; 95% CI, 1.19–2.72; p = 0.005). Adding PINRI improved the internally optimism-corrected C-statistic for dependency/death from 0.810 to 0.834 (difference, 0.024; p = 0.033). Comparator single-marker C-statistics were 0.821–0.825; none differed significantly from PINRI after false discovery rate (FDR) control. Conclusion: Higher admission PINRI and first-week PINRI burden were associated with a worse 180-day functional survival state and provided modest incremental information beyond the clinical model. Multicenter validation and local calibration are required before implementation.
SN - 1664-2295
ER -