Temporal pattern and prognostic value of serum NfL, GFAP and β-synuclein in acute ischemic stroke : a prospective single center cohort study

Abstract

Clinical outcomes after acute ischemic stroke (AIS) vary widely, and no serum biomarker is routinely used for prognosis. We analyzed the temporal pattern and prognostic value of serum neurofilament light chain (NfL), GFAP, and β-synuclein in 51 AIS patients at fixed time points up to the 5th day. Patients with poor functional outcome at 90 days (modified Rankin Scale 3–6) had consistently higher biomarker levels than those with good outcome (modified Rankin Scale 0–2). GFAP peaked on 3rd day, while NfL and β-synuclein peaked on the 5th day. GFAP on 3rd day showed the highest accuracy for predicting functional outcome, whereas NfL on the 5th day best distinguished survivors from non-survivors. All biomarkers moderately to strongly correlated with each other and with NIHSS, mRS, and ASPECTS. Serum NfL, GFAP, and β-synuclein are promising prognostic markers in AIS and warrant validation in larger cohorts.