A vitamin-biomarker risk score for 90-day functional outcome after acute ischemic stroke: development and internal...

The prognostic value of vitamin-related biomarkers in acute ischemic stroke (AIS) remains incompletely defined. This study evaluated associations between serum vitamin-related markers and 3-month functional outcome and developed an internally validated nomogram for individualized risk prediction.

Consecutive AIS patients admitted to Huludao Central Hospital between November 2024 and July 2025 were retrospectively included (n = 655). The analyzed sample included 342 men (52.2%) and 313 women (47.8%), with a mean age of 66.84 ± 9.85 years and a mean admission NIHSS score of 3.98 ± 4.35. Poor outcome was defined as a 3-month modified Rankin Scale (mRS) score of 3-6, and good outcome as mRS ≤ 2. Demographic and clinical characteristics, routine laboratory indices, and serum levels of vitamin D, vitamin E, vitamin A, vitamin K1, vitamin B12, folate, and homocysteine were collected. Candidate variables were screened by univariable analyses and entered into multivariable logistic regression. Multivariable analyses adjusted for age, sex, BMI, admission NIHSS score, infarct location, vascular risk factors, atrial fibrillation, coronary heart disease, moderate-to-severe arterial stenosis, serum albumin, and total protein. A nomogram was constructed using the rms package in R. Internal validation was performed with 1,000 bootstrap resamples. Discrimination, calibration, and clinical net benefit were assessed using receiver operating characteristic curves, calibration curves, and decision curve analysis.

Among 655 patients, 346 (52.82%) had poor outcomes and 309 (47.18%) had good outcomes at 3 months. Multivariable analysis identified vitamin D, vitamin E, vitamin A, vitamin K1, vitamin B12, folate, and homocysteine as independent predictors of poor outcome. The nomogram showed good discrimination, with an AUC of 0.878 in the training set and 0.880 in the test set, together with favorable calibration and decision-curve performance. In the test set, both the vitamin-based model and the combined model outperformed the clinical baseline model (AUC 0.884 and 0.886 vs. 0.734; DeLong p < 0.001), whereas the combined model did not significantly improve over the vitamin-based model (ΔAUC = -0.005; p = 0.582).

This serum vitamin-related biomarker nomogram may assist early risk stratification for 3-month functional outcome after AIS. However, as this was a single-center retrospective study with internal validation only, the model should be regarded as preliminary and requires external multicenter validation and prospective evaluation of clinical impact in patient management and outcomes before routine clinical use.