Longitudinal Inflammatory Trajectories and Recurrent Vascular Events After Acute Ischemic Stroke

Background Inflammation contributes to the pathophysiology of acute ischemic stroke, yet no inflammatory biomarker has been established as a standard prognostic tool. Most prior studies have relied on single baseline measurements, and the prognostic relevance of longitudinal inflammatory changes remains uncertain. We investigated whether baseline levels and longitudinal trajectories of inflammatory burden index (IBI) and hs‐CRP (high‐sensitivity C‐reactive protein) are associated with recurrent stroke and major adverse cardiovascular events (MACE). Methods In this prospective cohort study, 374 patients with acute ischemic stroke were analyzed. IBI was calculated as hs‐CRP multiplied by the neutrophil‐to‐lymphocyte ratio. Serum hs‐CRP and leukocyte differentials were measured within 24 hours of admission and at 6 months (±3 months). Baseline hs‐CRP was dichotomized at 2 mg/L and IBI at the median baseline value (4.03 mg/L), and longitudinal trajectories were defined as persistent low, increased, decreased, or persistent high based on changes between baseline and follow‐up measurements. Results During a median follow‐up of 30.5 months, 58 patients (15.5%) experienced recurrent stroke and 69 (18.4%) experienced MACE. Baseline IBI and hs‐CRP showed inconsistent associations with these outcomes. In contrast, persistent high IBI was associated with increased risks of recurrent stroke (hazard ratio [HR] 2.46; 95% CI, 1.26–4.78; P =0.008) and MACE (HR 2.42; 95% CI, 1.33–4.43; P =0.004) compared with persistent low IBI. Persistent high hs‐CRP was associated with MACE (HR 1.92; 95% CI, 1.08–3.41; P =0.026) but not with recurrent stroke. Conclusions Persistent high IBI trajectories were independently associated with recurrent stroke and MACE, and persistent high hs‐CRP trajectories were associated with MACE. Longitudinal assessment of inflammatory biomarkers may provide prognostic information beyond a single baseline measurement after ischemic stroke.