# Serum ferritin and admission stroke severity in first-ever acute ischemic stroke: a cross-sectional study

## TL;DR

Higher serum ferritin levels are linked to more severe stroke symptoms in first-time ischemic stroke patients, especially in younger individuals and those with specific stroke types.

## Contribution

This study reveals a U-shaped relationship between serum ferritin and stroke severity in first-ever acute ischemic stroke patients.

## Key findings

- Patients with NIHSS > 5 had significantly higher serum ferritin levels than those with NIHSS ≤ 5.
- Higher serum ferritin remained independently associated with greater neurological deficit after full adjustment.
- A U-shaped relationship was observed, with stronger associations in younger patients and those with small-artery occlusion subtype.

## Abstract

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.

To investigate the association between admission SF levels and stroke severity in patients with first-ever anterior circulation AIS.

This cross-sectional study included 288 patients with first-ever anterior circulation AIS admitted within 72 h of onset. SF was measured within 24 h 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.

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).

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.