Serum biomarker dynamics for predicting clinical outcomes and hemorrhagic transformation in acute ischemic stroke:A prospective cohort study

Background Acute ischemic stroke (AIS) has high disability and mortality. Hemorrhagic transformation (HT) is a critical complication related to astrocyte damage, axonal injury and inflammation. GFAP, NfL and IL-6 are closely associated with HT, but 7-day continuous dynamic data are lacking.Objective To investigate 7-day dynamic changes of serum GFAP, NfL, IL-6 and their predictive value for HT and 3-month functional outcomes in AIS patients.Methods A prospective cohort study including 308 AIS patients. Serum biomarkers were measured daily for 7 days. Predictive performance was analyzed by Cox regression, ROC analysis, calibration, and decision curve analysis (DCA).Results HT occurred in 13.6% (42/308) of patients. The 24-hour GFAP change rate independently predicted HT (HR = 1.041, 95% CI: 1.015–1.069, p = 0.002). The combined model had a bootstrap-corrected C-index of 0.877. Peak GFAP improved 3-month outcome prediction (AUC = 0.850, p = 0.048), outperforming NfL and IL-6.Conclusion The 24-hour GFAP change rate is a potential predictor for HT. Serial GFAP monitoring may provide preliminary evidence for early risk stratification of HT and functional outcomes in AIS patients.