The inflammation-fibrosis combined index as a predictor of prognosis in stroke patients undergoing mechanical thrombectomy

Background and purpose This study evaluates the novel Inflammation-Fibrosis Combined Index (IFCI) for predicting 90-day functional outcomes post-MT. Methods We conducted a retrospective analysis of 548 consecutive acute ischemic stroke patients treated with MT. The IFCI was derived from the combination of the Fibrosis-4 (FIB-4) index and the systemic immune-inflammation index (SII). The primary outcome was an unfavorable functional outcome (modified Rankin Scale score 3–6) at 90 days. The association between IFCI and the outcome was assessed using multivariable logistic regression and restricted cubic splines. Results Among the 548 patients (mean age 70.6 years, 56.2% male), 275 (50.2%) experienced an unfavorable outcome. In multivariable analysis, each 1-point increase in IFCI was independently associated with a 2.51-fold increased odds ratio of poor outcome (95% confidence interval [CI], 1.69–3.73; P = 0.001). Patients in the highest IFCI quartile had an 8.79-fold increased odds ratio compared to those in the lowest quartile (95% CI, 3.574–21.661; P = 0.001). The IFCI demonstrated superior discriminative ability (area under the curve [AUC] = 0.725) compared to FIB-4 (AUC = 0.683, P = 0.012) and SII (AUC = 0.604, P = 0.001). Adding IFCI to a model containing conventional risk factors significantly improved risk reclassification (continuous net reclassification improvement = 0.533, integrated discrimination improvement = 0.065; both P = 0.001). Conclusions By integrating the marker of inflammation and fibrosis pathways, the IFCI is an independent predictor of 90-day outcome after MT. It provides prognostic value beyond conventional variables and its individual components, and may serve as a useful tool for early risk assessment and patient management.