To investigate the predictive efficacy of the comprehensive inflammatory prognostic index (CIPI) for 90-day clinical prognosis in patients with acute ischemic stroke (AIS) undergoing reperfusion therapy, and to provide medical evidence for optimizing the prognostic assessment system in this patient population.

A total of 1 327 AIS patients who underwent reperfusion therapy at the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) from January 2022 to December 2024 were retrospectively enrolled. Baseline clinical data and routine blood test parameters obtained within 24 hours of symptom onset and before reperfusion therapy were collected to calculate the CIPI value. The modified Rankin scale (mRS) score at 90 days after symptom onset was set as the outcome measure, and patients were divided into a favorable prognosis group (mRS score 0-2) and an unfavorable prognosis group (mRS score 3-6). The baseline data between the two groups were compared. Univariate and multiple-model stepwise-adjusted logistic regression analyses were performed to analyze the association between CIPI and 90-day unfavorable prognosis. A restricted cubic spline (RCS) model was applied to explore the dose-response relationship between CIPI and the risk of unfavorable prognosis.

Among the 1 327 enrolled patients, 773 (58.25%) were assigned to the favorable prognosis group and 554 (41.75%) to the unfavorable prognosis group. The CIPI level in the unfavorable prognosis group was significantly higher than that in the favorable prognosis group [-0.302 (-2.147, 2.720) vs. -1.944 (-2.759, -0.061), Z = 9.078, P < 0.001]. Univariate logistic regression analysis showed that CIPI was a risk factor for 90-day unfavorable prognosis in AIS patients [odds ratio (OR) = 1.102, 95% confidence interval (CI) (1.071, 1.135), P < 0.001]. After stepwise adjustment for demographic characteristics, underlying medical history, and baseline National Institutes of Health Stroke Scale (NIHSS) score, CIPI remained an independent predictor of unfavorable prognosis [OR = 1.047, 95%CI (1.014, 1.082), P = 0.005]. The RCS model revealed a significant nonlinear association between CIPI and the risk of unfavorable prognosis (overall association P < 0.001, nonlinear association P < 0.001), with an accelerated upward trend in the risk of unfavorable prognosis as CIPI increased when CIPI ≥ -0.162.

CIPI is closely correlated with the 90-day prognosis of AIS patients undergoing reperfusion therapy. It is an independent predictor of unfavorable prognosis in this patient population, and can serve as a convenient assessment tool for early risk stratification of AIS after reperfusion therapy.