BRIEF RESEARCH REPORT article
Front. Neurol.
Sec. Stroke
This article is part of the Research TopicBrain Cytoprotection for Reperfusion Injury after Acute Ischemic StrokeView all 11 articles
Serum Ferritin and Admission Stroke Severity in First-Ever Acute Ischemic Stroke: A Cross-Sectional Study
Provisionally accepted
Ying Gao1,2*
Xinyi Xu1,2
Haoli Gao1,2*
Lei Ren1,2Yan Wang1,2
Chengboya Zhao1,2Yongwei Mu1,2Xiaolu Zhao1,2Xiaokun Yang1,2*
Jihua Liu1,2*
Xiudi Lu1,2- 1First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Nankai District, China
- 2National Clinical Medicine Research Center of Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Background: Iron dysregulation may aggravate ischemic brain injury through oxidative stress and ferroptosis. Serum ferritin (SF) reflects iron storage and inflammation, but its relationship with initial neurological deficit in first-ever acute ischemic stroke (AIS) remains unclear. Objective: To investigate the association between admission SF levels and stroke severity in patients with first-ever anterior circulation AIS. Methods:This cross-sectional study included 288 patients with first-ever anterior circulation AIS admitted within 72 hours of onset. SF was measured within 24 hours of admission. Stroke severity was assessed using the NIHSS; greater neurological deficit was defined as NIHSS > 5. Multivariable logistic regression, sensitivity analyses, and restricted cubic spline (RCS) modeling were performed. Subgroup analyses explored interactions with age, sex, and TOAST subtype. Results: The median age was 64 years, 66.0% were male, and the median NIHSS score was 3. Patients with NIHSS > 5 had higher SF (231.77 ng/mL [IQR 135.94–303.92]) than those with NIHSS ≤5 (175.00 ng/mL [117.12–231.81]; P = 0.003). After full adjustment, higher log-SF remained independently associated with NIHSS > 5 (OR = 2.12, 95% CI 1.18–3.81; P = 0.012). RCS analysis revealed a U-shaped relationship (P for non-linearity = 0.029), with stronger associations in patients <65 years (OR = 6.17, 95% CI 1.82–20.92; P = 0.004) and in small-artery occlusion subtype (OR = 4.20, 95% CI 1.41–12.47; P = 0.010). Conclusion: Among patients with first-ever anterior circulation AIS, serum ferritin showed a U-shaped association with neurological deficit. These results warrant validation in larger multicenter studies.
Keywords: Serum ferritin, Acute ischemic stroke, NIHSS, Neurological deficit, iron metabolism
Received: 11 Aug 2025; Accepted: 23 Oct 2025.
Copyright: © 2025 Gao, Xu, Gao, Ren, Wang, Zhao, Mu, Zhao, Yang, Liu and Lu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ying Gao, gy920716789@163.com
Haoli Gao, 3030727537@qq.com
Xiaokun Yang, yxk.666@163.com
Jihua Liu, ljh8941@163.com
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