A nutritional-inflammatory index for early prediction of inpatient urinary tract infection risk after acute stroke in the elderly

Shanhong Luo¹, Hongjuan Xu^2,*
1 Department of Intensive Care Unit, Taizhou People’s Hospital Affiliated to Nanjing Medical University, Taizhou, 225300, China
2 Department of Intensive Care Unit, Yancheng Tinghu District People’s Hospital, Yancheng, 225300, China
* Corresponding Author: Hongjuan Xu. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2025.069884

Received 02 July 2025; Accepted 17 October 2025; Published online 28 November 2025

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Abstract

Background: Early detection and timely treatment of urinary tract infections (UTIs) can prevent the aggravation of the inflammatory response following a stroke and enhance the recovery of neurological function. This study aimed to develop a simple scoring system by integrating nutritional and inflammatory markers to predict the occurrence of UTIs in patients with acute stroke. Methods: Reviews of 1011 patients with acute stroke were retrieved. The Geriatric Nutritional Risk Index (GNRI) and systemic inflammation response index (SIRI) were utilized to develop a composite score of nutritional-systemic inflammation response index (G-SIRI). The primary endpoint was the efficacy of predicting stroke-associated UTIs through an area under the curve (AUC) using receiver operating characteristic analysis. Secondary outcomes included the optimal cut-off value, hazard ratio (HR), in-hospital mortality, and length of hospital stay. Results: The composite scoring system of G-SIRI had a superior predictive accuracy for the occurrence of UTIs after acute stroke with a greater AUC of 0.850 (95% CI: 0.825–0.874) compared to either of isolated GNRI (0.782 [95% CI: 0.751–0.812]) or SIRI scores (0.796 [95% CI: 0.767–0.826]) (p < 0.001). A high-risk G-SIRI score was an independent predictor of stroke-associated UTI (HR = 2.192, 95% CI: 1.702–2.940) with a specificity of 0.784 and sensitivity of 0.899. A shorter survival time from post-stroke UTIs was observed in the high-risk G-SIRI cohort as opposed to the low-risk cohort (6.05 ± 1.14 vs. 3.22 ± 1.44 days, p < 0.001). The high-risk G-SIRI cohort showed significantly higher in-hospital mortality and longer length of hospital stays (all p < 0.05). Conclusions: The G-SIRI scoring system showed a superior efficacy in predicting stroke-associated UTIs as opposed to the individual GNRI or SIRI scores, which underscored the clinical utilization of integrating nutritional and inflammatory factors for UTI risk stratification among patients with acute stroke.