AUTHOR=Gao Ying , Xu Xinyi , Gao Haoli , Ren Lei , Wang Yan , Zhao Chengboya , Mu Yongwei , Zhao Xiaolu , Yang Xiaokun , Liu Jihua , Lu Xiudi 

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

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1683774

DOI=10.3389/fneur.2025.1683774

ISSN=1664-2295

ABSTRACT=BackgroundIron 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.ObjectiveTo investigate the association between admission SF levels and stroke severity in patients with first-ever anterior circulation AIS.MethodsThis 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.ResultsThe 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).ConclusionAmong 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.