Objective To investigate whether the neutrophil-to-albumin ratio (NPAR) predicts adverse outcomes in acute large vessel occlusion (LVO) stroke. Methods This cohort study enrolled 893 LVO stroke patients (2021–2023). Associations between NPAR and outcomes were assessed using logistic regression, restricted cubic spline, and ROC analysis. Results Higher NPAR correlated with elevated NIHSS, inflammatory markers, coagulation parameters, and dysphagia, and decreased hemoglobin, lymphocytes, and GCS. NPAR was an independent predictor for 90-day poor functional outcome (OR = 1.10, 95%CI: 1.07–1.14), pneumonia (OR = 1.14, 95%CI: 1.10–1.18), and intracerebral hemorrhage (ICH) (OR = 1.06, 95%CI:1.03–1.10). After multivariable adjustment, associations remained robust (aOR: 1.06–1.14). Linear dose–response relationships were observed. NPAR showed modest predictive performance (AUC: 0.60–0.65). Adding NPAR significantly improved pneumonia prediction over AIS-APS (AUC: 0.684 → 0.709, p = 0.0049), enhanced ICH sensitivity (56.6% → 64.6%), but minimally improved 90-day outcome prediction. Conclusion Elevated NPAR independently predicts pneumonia, ICH, and poor functional recovery in LVO stroke, serving as a potential early risk stratification tool. However, these findings should be interpreted in light of the study’s limitations, including its single-center retrospective design, single time-point NPAR measurement, and predominantly Han Chinese population, which may limit generalizability.
Yang et al. (Wed,) studied this question.