Biomarkers in Acute Ischemic Stroke Management
Summary
Acute ischaemic stroke remains a leading cause of disability and death worldwide. Rapid identification of the underlying pathology and prediction of clinical outcomes are critical to guide reperfusion strategies and neuroprotective interventions. Biomarkers detectable in peripheral blood offer a minimally invasive means to characterise tissue injury, inflammation and blood–brain barrier integrity. Protein markers such as glial fibrillary acidic protein and S100β reflect astrocyte damage and correlate with infarct size and haemorrhagic transformation risk. Neuronal proteins, including ubiquitin C-terminal hydrolase L1, rise early after neuronal injury, aiding in differentiation of stroke subtypes. Inflammatory indices derived from routine blood counts, such as the systemic inflammation response index, integrate neutrophil, lymphocyte and platelet counts to predict neurological deterioration and long-term functional outcome. Emerging optical and nanotechnology platforms promise rapid point-of-care quantification of key biomarkers en route to hospital. Together, these measures have the potential to refine patient selection for thrombolysis or thrombectomy, stratify risk of complications and inform prognostic discussions, thereby enhancing personalised management in the hyperacute setting.
Research from Nature Portfolio
Seminal work has demonstrated that combined measurement of neuronal and astrocytic proteins in serum can distinguish ischaemic from haemorrhagic stroke within hours of symptom onset. Serum levels of ubiquitin C-terminal hydrolase L1 and glial fibrillary acidic protein rise rapidly after cerebral injury, exhibiting distinct release profiles. Glial fibrillary acidic protein is markedly elevated in intracerebral haemorrhage compared with ischaemia, yielding high specificity for early rule-in of bleeding. Neuronal protein concentrations correlate with stroke severity but lack discriminatory power for subtype. These findings support a dual-marker approach to optimise early triage and guide hyperacute therapy decisions in stroke pathways.
Biomarkers in Acute Ischemic Stroke Management publication trend
The graph below shows the total number of articles in biomarkers in acute ischemic stroke management across all publications each year (not limited to Nature Index journals).
Technical terms
Glial fibrillary acidic protein (GFAP): Astrocyte-specific intermediate filament protein released into blood after astrocytic injury, used to differentiate haemorrhagic from ischaemic stroke.
Ubiquitin C-terminal hydrolase L1 (UCH-L1): Neuronal enzyme involved in protein degradation, released into circulation upon neuronal damage.
Systemic inflammation response index (SIRI): Composite marker calculated from neutrophil, monocyte and lymphocyte counts, reflecting systemic inflammatory status.
Systemic immune-inflammatory index (SII): Blood-derived index combining platelet, neutrophil and lymphocyte counts to assess immune-inflammatory balance.
Inflammatory prognostic index (IPI): Integrated biomarker incorporating C-reactive protein and lymphocyte counts to predict clinical outcomes in stroke.
S100β: Calcium-binding astroglial protein that indicates blood–brain barrier disruption and astrocyte damage, prognostic for infarct progression.
References
- The relationship between systemic inflammation index, systemic immune-inflammatory index, and inflammatory prognostic index and 90-day outcomes in acute ischemic stroke patients treated with intravenous thrombolysis. Journal of Neuroinflammation (2023).
- The association between serum S100β levels and prognosis in acute stroke patients after intravenous thrombolysis: a multicenter prospective cohort study. BMC Medicine (2024).
- Assessment of Serum UCH-L1 and GFAP in Acute Stroke Patients. Scientific Reports (2016).
- Upconversion nanoparticle-based optical biosensor for early diagnosis of stroke. Biosensors and Bioelectronics (2025).
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