Abstract: Background Axillary lymph node burden plays a certain prognostic role in breast cancer, with axillary high nodal burden (AHNB) indicating a poorer prognosis, often necessitating axillary lymph node dissection and adjuvant therapy. Immune-inflammatory index has been shown to be associated with the prognosis of various cancers, but their impact on axillary lymph node burden in triple-negative breast cancer remains unclear. Objective To analyze the predictive value of immune-inflammatory index on the occurrence of axillary lymph node metastasis and AHNB in triple-negative breast cancer and explore the risk factors for axillary lymph node burden. Methods A retrospective analysis was conducted on the clinical and pathological characteristics of operable triple-negative breast cancer patients treated at our breast surgery center from January 2010 to January 2023. The study included immune-inflammatory index such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and pan immune-inflammation value (PIV). Univariate and multivariate logistic regression analyses were performed to identify factors influencing axillary lymph node metastasis and AHNB in triple-negative breast cancer patients. Results A total of 408 patients with triple-negative breast cancer were included, including 255 (62.5%) axillary nodal negative patients, 78 (19.12%) axillary low nodal burden (ALNB) patients and 75 (18.38%)AHNB patients. Univariate Logistic regression analysis showed that histological grade, pathological type, tumor size, vascular invasion and NLR were correlated with axillary lymph node metastasis in triple negative breast cancer. Age, histological grade, tumor size and vascular invasion were correlated with AHNB. Multivariate Logistic regression analysis showed that the independent correlation factor of axillary lymph node metastasis in triple negative breast cancer was histological grade G3 (OR=2.081; 95% CI: 1.334-3.245), tumor ≥2 cm (OR=1.658; 95% CI: 1.083 - 2.539), vascular invasion (OR=2.884; 95% CI: 1.562 - 5.324). The independent association factor for AHNB was histology G3 (OR=2.391; 95% CI: 1.310 - 4.366), tumor ≥2 cm (OR=1.968; 95% CI: 1.130 -3.427), vascular invasion (OR=4.592; 95% CI: 2.433 - 8.665). Conclusion Histological grade, tumor size, and vascular invasion have a certain predictive value for axillary lymph node burden in triple-negative breast cancer patients, while the predictive ability of immune-inflammatory index for axillary lymph node burden is limited.