Comparison of PNI, HALP, and modified HALP scores in predicting 90-day mortality in elderly patients with acute ischemic stroke.

Introduction: Acute ischemic stroke (AIS) remains a major cause of mortality and disability, with older adults disproportionately affected. We aimed to evaluate and compare the prognostic utility of the Prognostic Nutritional Index (PNI), the Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score, and the modified HALP (mHALP) index for predicting 90-day mortality after AIS in a cohort predominantly composed of elderly patients. Methods: We conducted a single-center retrospective cohort study including 151 adult patients with radiologically confirmed AIS admitted to the emergency department between January 2021 and December 2024. Demographics, comorbidities, and laboratory parameters obtained within 24 hours of admission were recorded, and baseline stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). PNI, HALP, and mHALP were calculated from routine blood tests. The primary outcome was all-cause 90-day mortality. Associations with mortality were examined using univariate and pre-specified multivariable logistic regression models adjusted for age and NIHSS. Discriminatory performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: Overall, 26 patients (17.2%) died within 90 days. Non-survivors were older and had significantly lower albumin, hemoglobin, lymphocyte counts, PNI, and HALP values than survivors, and higher NIHSS at presentation. In univariate analyses, PNI, HALP, and mHALP were significantly associated with 90-day mortality. In multivariable models adjusted for age and NIHSS, both PNI and HALP remained independently associated with 90-day mortality, whereas the association for mHALP was attenuated and did not reach conventional statistical significance. ROC analyses indicated fair discrimination for PNI and HALP, modest-to-fair performance for mHALP, and NIHSS performance comparable to a clinical reference. Discussion: In this AIS cohort, simple immunonutritional indices-particularly PNI and HALP-were independently associated with 90-day mortality and demonstrated fair discriminative ability, supporting their potential role as adjunctive tools for early risk stratification. These findings warrant validation in larger prospective multicenter cohorts and further clarification of the prognostic contribution of mHALP in AIS.