Combined Inflammatory Burden Index and hand grip strength for prognostic assessment in gastric cancer patients: a multicenter cohort study

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Background Gastric cancer (GC) is associated with heterogeneous prognosis, and individual inflammatory or nutritional markers have limited predictive value. This study aimed to develop and evaluate a novel grading system integrating the Inflammatory Burden Index (IBI) and handgrip strength (HGS) for prognostic assessment in GC. Methods Kaplan–Meier curves and log-rank tests were used for survival comparisons. Multivariate Cox and logistic regression analyses were performed to evaluate the independent associations between the IBI-HGS grade and overall survival (OS) as well as severe malnutrition. Sensitivity analyses excluding early deaths were conducted to assess the robustness of the results. Results This multicenter retrospective cohort study included 1,052 GC patients. During a median follow-up duration of 20.75 months, 455 deaths occurred. A three-tier IBI-HGS grade (low-, medium-, and high-risk) was established by combining IBI and HGS. Kaplan–Meier analysis demonstrated significant differences in OS among the IBI-HGS grades: 67.9% in the low-risk group, 58.4% in the medium-risk group, and 44.9% in the high-risk group (log-rank p < 0.001). Multivariate Cox regression analysis showed that the medium-risk grade was associated with a 69.1% higher risk of mortality (HR = 1.691, 95% CIs: 1.323–2.162, p < 0.001), while the high-risk grade was associated with a 123.0% increased risk (HR = 2.230, 95% CI: 1.690–2.942, p < 0.001). Multivariate logistic regression analysis confirmed that the medium-risk grade was associated with a 56.2% higher risk of severe malnutrition (OR = 1.562, 95% CIs: 1.167–2.091, p = 0.003), whereas the high-risk grade was associated with a 205.8% increased risk (OR = 3.058, 95% CI: 2.110–4.431, p < 0.001). Sensitivity analyses further confirmed these independent prognostic associations. Conclusion The novel IBI-HGS grade, integrating systemic inflammatory burden and skeletal muscle function, is a simple, noninvasive, and clinically practical biomarker. It was independently associated with OS and baseline severe malnutrition, enabling refined prognostic stratification and supporting the identification of GC patients with poor nutritional status. Clinical trial registration http://www.chictr.org.cn/showproj.aspx?proj=33675 , ChiCTR1800020329.

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