Abstract
OBJECTIVE: To assess the diagnostic value of serum NLRP3 inflammasome and occludin levels in predicting hemorrhagic transformation (HT) and functional outcomes in acute ischemic stroke (AIS). METHODS: AIS patients and matched controls were enrolled between June and November 2021. Serum biomarkers were measured and correlated with infarct volume, stroke severity, HT occurrence, and prognosis. Predictive performance was evaluated using logistic regression and ROC curves. RESULTS: A total of 156 AIS patients and 55 controls were included. AIS patients showed significantly elevated serum NLRP3 (56.59 pg/mL vs. 33.24 pg/mL) and occludin levels (97.42 ng/mL vs. 44.54 ng/mL) (both p <0.001). Both biomarkers correlated positively with infarction volume and NIHSS scores. HT occurred in 19.2% of patients, who exhibited markedly higher NLRP3 and occludin levels (both p<0.001). NLRP3 levels differed significantly between HI and PH subtypes (p = 0.042). Logistic regression identified infarct volume, creatinine, reperfusion therapy, and NLRP3 as independent predictors of HT. Poor functional outcomes were associated with older age, atrial fibrillation, HT, larger infarcts, higher NIHSS scores, and elevated serum biomarkers (all p <0.05). Age, NIHSS, LDL-C, and NLRP3 independently predicted prognosis. The optimal NLRP3 cut-off for predicting HT was 80.86 pg/mL (AUC 0.911), and for poor prognosis 82.75 pg/mL (AUC 0.663). Combining NLRP3 with NIHSS significantly enhanced prognostic accuracy (AUC 0.903). CONCLUSIONS: Elevated serum NLRP3 inflammasome levels represent a promising biomarker for predicting HT and unfavorable outcomes in AIS patients.