The association between the ZJU index and short-term prognosis in patients with acute ischemic stroke: a cohort study.

OBJECTIVE: This study aimed to evaluate the ZJU index-a composite metabolic indicator integrating fasting plasma glucose, body mass index, ALT/AST ratio, and triglycerides-as a predictor of short-term functional outcomes in patients with Acute Ischemic Stroke (AIS) Given the lack of research on this association, the study sought to provide a novel prognostic tool and enhance understanding of metabolic factors in stroke recovery. METHODS: This was a post-hoc analysis based on a prospective longitudinal registry database from a single center in Korea. A cohort of 1897 AIS patients was included. The ZJU index was calculated as: FPG (mmol/L) + BMI (kg/m²) + 3 × (ALT/AST ratio) +2 (if female) + TG (mmol/L). Multivariable logistic regression analysis was employed to assess the association between the ZJU index and poor functional outcome (modified Rankin Scale score >2) at 3-month, with sequential adjustments for demographic, clinical, and laboratory confounders. Restricted cubic spline analysis was used to explore the shape of the association, and subgroup analyses were conducted to examine the consistency of the association across different populations. RESULTS: Multivariable logistic regression revealed a significant negative correlation between the ZJU index and short-term prognosis in AIS patients (after full adjustment for confounders, continuous variable OR = 0.975, 95% CI: 0.952-0.998). Using the first quartile (Q1) of the ZJU index as reference, patients in the second to fourth quartiles (Q2-Q4) had significantly lower risks of poor prognosis. Restricted cubic spline analysis further indicated a significant non-linear negative correlation between the two (Overall P < 0.001, Non-linear P = 0.013), presenting a threshold nonlinear trend that the risk of poor functional outcome decreased rapidly with elevated ZJU index and plateaued after reaching a critical cut-off value. Extensive subgroup analyses showed that, except in the diabetes subgroup, this protective association remained consistent across patients of different genders, ages, hyperlipidemia status, smoking status, and history of coronary heart disease. CONCLUSION: This study demonstrates that ZJU index is independently associated with short-term functional outcomes in AIS patients, and this association is non-linear. As a composite metabolic indicator, the ZJU index holds potential clinical value for assessing prognosis risk and guiding personalized metabolic management in AIS patients.