BACKGROUND: Angiopoietin-like protein 4 (ANGPTL4) is critical for vascular integrity and reducing inflammation in ischemic and hypoxic brain injuries. However, limited studies have evaluated ANGPTL4's role in acute ischemic stroke (AIS) assessment, and its expression patterns across AIS phases remain unclear. METHODS: The severity of AIS at admission was assessed using the National Institutes of Health Stroke Scale (NIHSS). The association between serum ANGPTL4 level and the occurrence of AIS was examined using logistic regression analysis. The diagnostic accuracy of serum ANGPTL4 level for AIS severity was assessed using receiver operating characteristic curves. RESULTS: This study included 389 AIS patients and 133 healthy individuals. There was a notable increase in the occurrence of AIS associated with rising serum ANGPTL4 levels (odds ratio [OR] 1.03, 95% confidence interval [CI]: 1.02-1.06
p <
0.001). A higher serum level of ANGPTL4 was also found to be associated with severe AIS, as indicated by an AUC of 0.848. Additionally, we observed significant dynamic changes in ANGPTL4 levels, with a marked decrease at 1 week or 2 weeks after admission compared with the acute phase (the day after admission
both p <
0.001). CONCLUSIONS: Our findings suggest a robust association between elevated serum ANGPTL4 levels and the presence and severity of AIS. Importantly, this study is distinguished by its novel focus on the temporal dynamics of ANGPTL4 levels, which underscores its potential as a biomarker for AIS monitoring and provides new insights into AIS pathophysiology.