Objective To investigate the diagnostic value of peripheral blood trimethylamine N-oxide (TMAO) combined with neutrophil-to-lymphocyte ratio (NLR) in patients with acute ischemic stroke (AIS).

Methods A total of 100 AIS patients were selected as study group, and 100 non-stroke study objects who underwent physical examinations during the same period were selected as control group. Blood samples were collected from all participants, and plasma TMAO levels were measured using high-performance liquid chromatography-tandem mass spectrometry. TMAO levels and NLR were compared between two groups, and Spearman correlation analysis, multivariate logistic regression analysis, and receiver operating characteristic (ROC) curve were applied to evaluate the diagnostic value of TMAO and NLR in AIS.

Results Compared with the control group, the AIS group had significantly higher TMAO levels and NLR (P < 0.05). Spearman correlation analysis indicated that TMAO and NLR were positively correlated with the occurrence of AIS (P < 0.05). Multivariate Logistic regression analysis revealed that age, TMAO, NLR, and hypertension were independent influencing factors for the occurrence of AIS (P < 0.05). The ROC curve showed that the optimal cut-off values for TMAO and NLR in predicting AIS were 3.749 μmol/L and 2.210, respectively. The area under the curve for TMAO combined with NLR in predicting AIS was 0.902, which was higher than that of TMAO or NLR alone (0.808 and 0.801, respectively), and the Youden index for combined prediction was greater.

Conclusion Peripheral blood TMAO and NLR are positively correlated with the occurrence of AIS, and the combination of TMAO and NLR can significantly improve the diagnostic efficacy of AIS, providing a basis for early clinical identification of AIS.