Relationship between prognostic nutritional index and post-stroke cognitive impairment

ABSTRACT

Background

The Prognostic Nutritional Index (PNI) has been described as a useful screening tool for patient prognosis in several diseases. As a potential diagnostic index, it has attracted the interest of many physicians. However, the correlation between the PNI and post-stroke cognitive impairment (PSCI) remains unclear.

Methods

A total of 285 patients with acute ischemic stroke were included. PNI was assessed as serum albumin (g/L) + 5× lymphocyte count (10⁹/L) and was dichotomized according to the prespecified cut-off points 48.43 for the high and low groups. PSCI was defined as Mini-Mental State Examination (MMSE) < 27 at the 6–10 months follow-up. Multiple logistic regression and linear regression analyses were performed to examine the association between PNI and cognitive outcomes.

Results

A low PNI was independently associated with PSCI after adjusting for age, sex, education, National Institutes of Health Stroke Scale (NIHSS), deep white matter hyperintensity (DWMH), and stroke history (odds ratio [OR]: 2.158; 95% confidence interval [CI]: 1.205–3.863). The PNI scores were significantly associated with MMSE and attention domain (β = 0.113, p = 0.006; β = 0.109, p = 0.041, respectively). The PNI improved the model’s discrimination when added to the model with other clinical risk factors.

Conclusions

A low PNI was independently associated with the occurrence of PSCI and the PNI scores were specifically associated with the scores of global cognition and attention domain. It can be a promising and straightforward screening indicator to identify the person with impaired immune-nutritional status at higher risk of PSCI.

KEYWORDS:

• Prognostic nutritional index
• nutrition
• stroke
• post-stroke cognition impairment

Acknowledgements

Author contributions: Conceptualization, Yongchun Wang and Li Sun; Formal analysis, Yongchun Wang, Guimei Zhang, Panpan Zhao, Yanxin Shen; Methodology, Yongchun Wang and Hui Sun; Supervision, Yingshi Ji and Li Sun; Writing – original draft, Yongchun Wang; Writing – review & editing, Yongchun Wang.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Datasets are available from the corresponding author on reasonable request.

Ethics statement

The studies involving human participants were reviewed and approved by The First Hospital of Jilin University. The patients/participants provided their written informed consent to participate in this study.

Additional information

Funding

This work was supported by the grants from National Natural Science Foundation of China [grant number 82071442] and the Jilin Provincial Department of Finance [grant number JLSWSRCZX2021-004].

Notes on contributors

Yongchun Wang

Yongchun Wang, is a MD student at Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China.

Guimei Zhang

Guimei Zhang, is a MD student at Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China.

Yanxin Shen

Yanxin Shen, is a MD student at Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China.

Panpan Zhao

Panpan Zhao, is a MD student at Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China.

Hui Sun

Hui Sun, is a MD student at Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China.

Yingshi Ji

Yingshi Ji, is a professor at Department of Pharmacology, Physiology and Cell Biology, College of Basic Medical Sciences, Jilin University, China.

Li Sun

Li Sun, is a professor at Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China.