Abstract
BACKGROUND: Inflammatory and coagulation pathways contribute to the pathophysiology of acute ischemic stroke. High sensitivity C reactive protein and D Dimer are routinely measured biomarkers; however, their clinical relevance for early stroke severity and functional outcome, particularly across age groups, remains incompletely defined. METHODS: This retrospective cohort study included 622 patients with imaging confirmed acute ischemic stroke admitted between January 2023 and June 2025. Admission National Institutes of Health Stroke Scale scores, vascular risk factors, and laboratory biomarkers including hs CRP and D Dimer were collected within twenty four hours of admission. Functional outcome at discharge was assessed using the modified Rankin Scale and dichotomized as good (≤ 2) or poor (> 2). Associations between biomarkers, stroke severity, and outcome were evaluated using correlation analyses and multivariable logistic regression. Age stratified analyses were performed as a secondary objective. RESULTS: The median admission NIHSS score was 2 (interquartile range 1–5). hs CRP levels were positively correlated with NIHSS scores (Spearman rho 0.21, p < 0.001), as were D Dimer levels (Spearman rho 0.16, p < 0.001). Patients with poor functional outcome had higher admission hs CRP levels (p = 0.004) and higher NIHSS scores (p < 0.001). In multivariable analysis, higher NIHSS score (odds ratio 1.32, 95% confidence interval 1.18–1.48) and hypertension (odds ratio 2.11, 95% confidence interval 1.19–3.72) were independently associated with poor outcome, while hs CRP showed a borderline association and D Dimer was not independently associated after adjustment. Associations between biomarkers and stroke severity were consistent across age groups. CONCLUSIONS: Admission hs CRP and D Dimer levels are modestly associated with initial stroke severity in acute ischemic stroke, while elevated hs CRP is associated with poor early functional outcome at hospital discharge. These associations appear largely mediated by stroke severity. Stroke severity and hypertension remain the strongest predictors of early recovery. Inflammatory biomarkers may provide adjunctive information for early risk stratification when interpreted alongside established clinical assessments. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12883-026-04797-6.