Frontiers in nutrition · 2026
Associations of inflammation-related nutritional and metabolic status indices CAR and CTI with 90-day unfavorable functional outcomes in patients with acute ischemic stroke.
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Liu Xijun, Zheng Xiaojuan, Chen Zeru, Chen Haiwei, Xie Mingxi, Zhang Jing
Аннотация
BACKGROUND: Composite indices integrating inflammation, nutritional reserve, and metabolic status may improve early prognostic assessment after acute ischemic stroke (AIS). This study examined the associations of the C-reactive protein-to-albumin ratio (CAR) and the CRP-triglyceride-glucose index (CTI) with 90-day functional outcomes.
METHODS: A Korean single-center stroke registry (2010-2016) was analyzed (n = 1,484). CAR and CTI were calculated from admission laboratory tests. The primary endpoint was 90-day unfavorable functional outcome defined as modified Rankin Scale 3-6. Associations were examined using multivariable logistic regression with standardized exposures; restricted cubic splines assessed non-linearity. Prognostic performance was evaluated using receiver operating characteristic analysis and a parsimonious model derived with penalized regression. Internal validation was performed using repeated 10-fold cross-validation, and model calibration was assessed using a calibration plot, calibration intercept, calibration slope, and Brier score.
RESULTS: Unfavorable outcomes occurred in 414 patients (27.9%). After full adjustment, higher CAR (OR 1.25, 95% CI 1.09-1.43) and higher CTI (OR 1.38, 95% CI 1.19-1.60) were independently associated with unfavorable outcome. CTI showed an approximately linear risk gradient, whereas CAR showed evidence of a non-linear association. As single predictors, CAR and CTI yielded AUCs of 0.656 and 0.651 and outperformed albumin, triglycerides, and fasting plasma glucose. A six-variable model including sex, age, body mass index, admission NIHSS, CAR, and CTI achieved an apparent AUC of 0.837. Internal validation showed stable performance, with a mean cross-validated AUC of 0.831, mean Brier score of 0.142, calibration intercept of 0.023, and calibration slope of 1.018.
CONCLUSION: CAR and CTI, derived from routine admission laboratory tests, were associated with 90-day functional outcomes after acute ischemic stroke and may aid early prognostic assessment. The derived six-variable model showed acceptable internal performance, but should be considered exploratory pending external validation.
METHODS: A Korean single-center stroke registry (2010-2016) was analyzed (n = 1,484). CAR and CTI were calculated from admission laboratory tests. The primary endpoint was 90-day unfavorable functional outcome defined as modified Rankin Scale 3-6. Associations were examined using multivariable logistic regression with standardized exposures; restricted cubic splines assessed non-linearity. Prognostic performance was evaluated using receiver operating characteristic analysis and a parsimonious model derived with penalized regression. Internal validation was performed using repeated 10-fold cross-validation, and model calibration was assessed using a calibration plot, calibration intercept, calibration slope, and Brier score.
RESULTS: Unfavorable outcomes occurred in 414 patients (27.9%). After full adjustment, higher CAR (OR 1.25, 95% CI 1.09-1.43) and higher CTI (OR 1.38, 95% CI 1.19-1.60) were independently associated with unfavorable outcome. CTI showed an approximately linear risk gradient, whereas CAR showed evidence of a non-linear association. As single predictors, CAR and CTI yielded AUCs of 0.656 and 0.651 and outperformed albumin, triglycerides, and fasting plasma glucose. A six-variable model including sex, age, body mass index, admission NIHSS, CAR, and CTI achieved an apparent AUC of 0.837. Internal validation showed stable performance, with a mean cross-validated AUC of 0.831, mean Brier score of 0.142, calibration intercept of 0.023, and calibration slope of 1.018.
CONCLUSION: CAR and CTI, derived from routine admission laboratory tests, were associated with 90-day functional outcomes after acute ischemic stroke and may aid early prognostic assessment. The derived six-variable model showed acceptable internal performance, but should be considered exploratory pending external validation.