Risk of Pre-Stroke Malnutrition Predicts Mortality in Ischaemic Stroke Patients Undergoing Thrombectomy

Malnutrition is common in older adults but poorly studied in acute ischaemic stroke (AIS) patients treated with endovascular thrombectomy (EVT). This study assesses the prevalence of malnutrition risk at Stroke Unit admission, related clinical factors, and its impact on EVT outcomes, functional status and 90-day mortality.

Retrospective single-centre study on consecutive EVT-treated AIS patients (2021-2024). Malnutrition risk was assessed using the GNRI ([1.489 × serum albumin g/L] + [41.7 × current/ideal body weight]). For the primary analyses, patients with GNRI ≤ 98 were classified as at risk of malnutrition (RoM+); secondary analyses further stratified moderate-to-severe risk (GNRI < 92). Logistic regression was used to identify factors associated with RoM+ and to evaluate its impact on (1) EVT performance measures, (2) 90-day mRS and (3) 90-day mortality. Multivariable models included variables with p < 0.10 in univariate testing, and the robustness of outcome analyses was assessed through sensitivity models including predefined clinically relevant covariates.

Among 306 patients, 43.8% were classified as RoM+, including 24.5% with moderate-to-severe nutritional risk. In the multivariable model, RoM+ was independently associated with older age (aOR 1.03, 95% CI 1.00-1.06), higher pre-stroke disability (aOR 1.48, 95% CI 1.12-1.95) and a lower prevalence of dyslipidemia (aOR 0.59, 95% CI 0.35-0.97) and was not associated with EVT efficacy or safety. RoM+ was independently associated with increased 90-day mortality (aOR 2.37, 95% CI 1.06-5.28), while the association with functional outcome did not reach statistical significance (aOR 1.58, 95% CI 0.98-2.55). Secondary analyses using GNRI severity strata and predefined sensitivity models showed consistent results.

At admission, ~44% of EVT-treated AIS patients are at risk of malnutrition, which independently predicted 90-day mortality. Pre-stroke nutritional status may represent a modifiable prognostic factor in stroke care and warrants further prospective investigation.