Inflammatory Burden Index and One-Year Clinical Outcomes in Large Artery Atherosclerosis Ischemic Stroke: A Multicenter Prospective Study.

background and purposeThe inflammatory burden index (IBI) is a novel composite biomarker designed to assess systemic inflammation, but its prognostic value in large-artery atherosclerosis (LAA) ischemic stroke remains unestablished. We evaluated IBI's association with 1-year clinical outcomes in LAA stroke patients.

methodsIn this multicenter prospective study, 2815 LAA stroke patients were assessed for mortality, recurrence, dependency (mRS 3-5), and poor functional outcome (mRS 3-6). Multivariable-adjusted Cox/logistic models analyzed associations between admission IBI and outcomes. Comparative analyses used ROC curves with DeLong's test and quantified incremental value through net reclassification improvement (NRI)/integrated discrimination improvement (IDI).

resultsMedian IBI was 11.2 (IQR 5.4-25.8). At 1 year, outcomes included: mortality 3.2% (n = 90), recurrence 8.3% (n = 235), dependency 11.5% (n = 324), and poor outcome 14.7% (n = 414). Elevated IBI levels were significantly associated with increased all-cause mortality (hazard ratio [HR] 4.26; 95% confidence interval [CI], 1.76-10.33), stroke recurrence (HR 1.63; 95% CI, 1.10-2.42), dependency (odds ratio [OR] 1.81; 95% CI, 1.24-2.66), and poor functional outcome (OR 2.41; 95% CI, 1.69-3.43). IBI demonstrated superior discrimination for dependency (AUC 0.86) and poor outcome (AUC 0.86) compared with NLR, PLR, SII, and CRP (all p < 0.01 by DeLong's test). Adding IBI to conventional risk models significantly improved reclassification and discrimination for all the clinical outcomes.

conclusionsElevated admission IBI independently predicts 1-year mortality, recurrence, dependency, and functional impairment in LAA stroke. IBI provides significant prognostic value beyond conventional inflammatory markers and clinical risk models.