Prognostic Significance of Serum Ferritin in Patients with Acute Ischemic Stroke: A Prospective Observational Study
Abstract
Background: Serum ferritin, an indicator of body iron stores as well as an acute-phase reactant, has been investigated as a potential prognostic biomarker in acute ischaemic stroke (AIS). This study evaluated the prognostic relevance of serum ferritin, its association with functional outcome using the modified Rankin Scale (MRS), and its relationship with established vascular risk factors in patients with AIS. Methods: This prospective observational study was conducted in the Department of General Medicine, Government Mohan Kumaramangalam Medical College Hospital, Salem, between November 2018 and August 2019. Sixty patients with AIS presenting within 48 hours of symptom onset were enrolled after informed consent. Baseline demographic, clinical, and laboratory characteristics were recorded. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at admission, and functional outcome was evaluated using the mRS at 4 weeks. Serum ferritin was measured at admission. Results: The mean age was 59.68 ± 10.12 years, and 70% were men. At 4 weeks, 33.3% had good (mRS 1–2) and 66.7% had poor (mRS 3–6) functional outcomes. Mean serum ferritin was 229.71 ± 132.02 ng/mL. Ferritin correlated weakly with age (r=0.309, p=0.016) but not with hypertension, diabetes mellitus, dyslipidaemia, smoking, or alcohol use. Ferritin was significantly higher in patients with poor than good outcome (266.2 ± 131.0 vs. 156.8 ± 103.5 ng/mL; p=0.002). Every 50 ng/mL ferritin increase independently increased the odds of poor outcome by 38% (aOR 1.38; 95% CI: 1.05–1.82; p=0.021). ROC analysis showed an AUC of 0.758; a ≥205 ng/mL cut-off provided 75% sensitivity and 70% specificity. Conclusion: Higher admission serum ferritin was independently associated with poor 4-week functional outcome in AIS and demonstrated moderate predictive ability, supporting its potential role as an adjunctive prognostic marker.