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Background <p>Inflammation and malnutrition are well-recognized contributors to adverse outcomes in patients with acute ischemic stroke (AIS). The advanced lung cancer inflammation index (ALI), a composite biomarker of inflammation and nutritional status that incorporates body mass index (BMI), albumin (ALB), and neutrophil-to-lymphocyte ratio (NLR), has demonstrated prognostic value in various clinical settings, but evidence in AIS remains limited. We aimed to evaluate the association between ALI and multiple adverse outcomes in patients with AIS and to compare its predictive performance with that of its individual components.</p> Methods <p>A multicenter prospective cohort study was conducted including 12,911 individuals with AIS from the Third China National Stroke Registry. Multivariable logistic and Cox proportional hazards regression analyses were used to estimate the association between ALI and all-cause mortality, combined vascular events (CVE), stroke recurrence, and poor functional outcome [modified Rankin Scale (mRS) score 3–6] at 3-month and 1-year follow-up. Non-linear relationships were investigated using restricted cubic splines (RCS). Predictive performance was assessed using receiver operating characteristic curves with DeLong’s test, and model calibration was evaluated using calibration curves.</p> Results <p>After adjustment for confounders, each IQR increase in ALI was associated with reduced risks of all-cause mortality (HR 0.61, 95% CI 0.52–0.72), poor functional outcome (OR 0.73, 95% CI 0.69–0.77), stroke recurrence (HR 0.87, 95% CI 0.82–0.93), and CVE (HR 0.87, 95% CI 0.82–0.93) at 3&#xa0;months. Quartile-based analysis further demonstrated a dose–response relationship, with patients in the highest quartile showing the lowest risks (all P for trend &lt; 0.0001). RCS analysis revealed approximately L-shaped nonlinear relationships. Furthermore, ALI demonstrated superior predictive value for all-cause mortality (AUC = 0.736) and poor functional outcome (AUC = 0.666) compared to BMI, ALB, and NLR (all P &lt; 0.005), with good calibration. Similar results were observed at 1&#xa0;year.</p> Conclusions <p>Higher baseline ALI was independently associated with reduced risks of all-cause mortality, poor functional outcome, CVE, and recurrence in patients with AIS. ALI demonstrated moderate to good predictive value with good calibration for mortality and poor functional outcome, whereas its discriminative ability for stroke recurrence and CVE was limited. Further validation in diverse populations and evaluation of incremental predictive value are warranted.</p> Clinical trial number <p>Not applicable.</p>

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Advanced lung cancer inflammation index, a composite marker of inflammation and nutritional status, was associated with adverse outcomes in acute ischemic stroke: a prospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年5月29日

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  • Yishuang Zhao,
  • Kaixuan Yang,
  • Chunchen Xiang,
  • Yumei Zhang

摘要

Background

Inflammation and malnutrition are well-recognized contributors to adverse outcomes in patients with acute ischemic stroke (AIS). The advanced lung cancer inflammation index (ALI), a composite biomarker of inflammation and nutritional status that incorporates body mass index (BMI), albumin (ALB), and neutrophil-to-lymphocyte ratio (NLR), has demonstrated prognostic value in various clinical settings, but evidence in AIS remains limited. We aimed to evaluate the association between ALI and multiple adverse outcomes in patients with AIS and to compare its predictive performance with that of its individual components.

Methods

A multicenter prospective cohort study was conducted including 12,911 individuals with AIS from the Third China National Stroke Registry. Multivariable logistic and Cox proportional hazards regression analyses were used to estimate the association between ALI and all-cause mortality, combined vascular events (CVE), stroke recurrence, and poor functional outcome [modified Rankin Scale (mRS) score 3–6] at 3-month and 1-year follow-up. Non-linear relationships were investigated using restricted cubic splines (RCS). Predictive performance was assessed using receiver operating characteristic curves with DeLong’s test, and model calibration was evaluated using calibration curves.

Results

After adjustment for confounders, each IQR increase in ALI was associated with reduced risks of all-cause mortality (HR 0.61, 95% CI 0.52–0.72), poor functional outcome (OR 0.73, 95% CI 0.69–0.77), stroke recurrence (HR 0.87, 95% CI 0.82–0.93), and CVE (HR 0.87, 95% CI 0.82–0.93) at 3 months. Quartile-based analysis further demonstrated a dose–response relationship, with patients in the highest quartile showing the lowest risks (all P for trend < 0.0001). RCS analysis revealed approximately L-shaped nonlinear relationships. Furthermore, ALI demonstrated superior predictive value for all-cause mortality (AUC = 0.736) and poor functional outcome (AUC = 0.666) compared to BMI, ALB, and NLR (all P < 0.005), with good calibration. Similar results were observed at 1 year.

Conclusions

Higher baseline ALI was independently associated with reduced risks of all-cause mortality, poor functional outcome, CVE, and recurrence in patients with AIS. ALI demonstrated moderate to good predictive value with good calibration for mortality and poor functional outcome, whereas its discriminative ability for stroke recurrence and CVE was limited. Further validation in diverse populations and evaluation of incremental predictive value are warranted.

Clinical trial number

Not applicable.