Baseline nutritional risk predicts 90-day outcome after mechanical thrombectomy

Malnutrition affects up to 30-50% of patients with acute ischemic stroke and is independently associated with infectious complications, worse functional recovery, and increased mortality; yet its prognostic impact in the specific setting of mechanical thrombectomy (MT) for large-vessel occlusion (LVO) remains poorly characterized. We aimed to determine whether baseline nutritional status, assessed by the Controlling Nutritional Status (CONUT) score, independently predicts 90‑day functional outcome and mortality after MT.

A retrospective cohort of 385 consecutive patients with acute ischemic stroke due to large-vessel occlusion was analysed. The patients were treated with mechanical thrombectomy. The initial nutritional status of the participants was evaluated using the CONUT score, which was analysed both as a continuous variable and according to conventional severity categories. The primary outcomes were poor functional outcome at 90 days (modified Rankin Scale [mRS] 3-6) and 90-day all-cause mortality. Univariable and multivariable logistic regression models were fitted, and model performance was assessed by discrimination and calibration metrics.

Patients were distributed across CONUT categories as follows: normal 96 (21%), mild 169 (37%), moderate 99 (21%), and severe 21 (5%). Higher CONUT categories were associated with progressively worse 90‑day mRS distributions. In multivariable analyses, higher CONUT score remained independently associated with poor functional outcome (adjusted odds ratio [OR] 1.195 per point; 95% confidence interval [CI] 1.048-1.363; p = 0.008) and with 90‑day mortality (adjusted OR 1.258; 95% CI 1.113-1.420; p < 0.001). Model discrimination was good for poor functional outcome (AUC 0.846; 95% CI 0.798-0.894) and moderate for mortality (AUC 0.758; 95% CI 0.689-0.827). Inclusion of CONUT score improved risk stratification and clinical net benefit beyond a clinical-radiological base model.

In this real‑world MT cohort, higher baseline CONUT was independently associated with greater 90‑day disability and mortality after adjustment for established clinical, imaging, and procedural factors. Routine CONUT assessment at admission may enhance risk stratification, facilitate early nutritional consultation, and inform post-acute care planning in MT candidates. Whether targeted nutritional interventions can improve outcomes in patients with high CONUT scores warrants prospective evaluation.