Objective To investigate the relationship between nutritional risk indexes and neurological prognosis in elderly patients with severe craniocerebral injury.Methods A total of 127 elderly patients with severe craniocerebral injury admitted to our hospital from May 2019 to October 2021 were enrolled in this retrospective study.The nutritional risk of the patients was assessed by the prognostic nutritional index(PNI)and nutrition risk in critically ill(NUTRIC)score.Multivariate logistic analysis was used to identify the risk factors affecting the prognosis of neurological function(modified Rankin scale,mRS)at 6 months of onset and a risk model was constructed.Results The patients with PNI<45 had lower Glasgow coma score(GCS)and higher proportions of pulmonary infection and mRS≥3 than the patients with PNI≥45(all P<0.05).The patients with NUTRIC≥5 had lower GCS and higher proportion of mRS≥3 than the patients with NUTRIC<5(all P<0.05).The patients with mRS≥3 were older and had higher proportions of open injury,closed injury,pulmonary infection and subarachnoid hemorrhage,higher NUTRIC score and lower GCS and PNI than the patients with mRS<3(all P<0.05).Age,pulmonary infection,GCS and PNI were risk factors affecting the prognosis of neurological function.The area under the curve(AUC)of the risk model based on the PNI for identifying poor neurological prognosis in elderly patients with severe brain injury was 0.92,with a sensitivity and specificity of 79.5%and 90.7%,respectively.The AUC of the model based on the NUTRIC score was 0.89,with a sensitivity and specificity of 89.0%and 79.6%,respectively.Conclusion Nutritional status assossment based on PNI and NUTRIC score is closely related to the neurological prognosis in patients with severe craniocerebral injury at 6 months after onset.The short-term neurological prognosis is poor in elderly patients with poor nutritional status.