Association of blood nardilysin and neurogranin levels with early outcomes in transient ischemic attack: A prospective cohort study

Transient ischemic attack (TIA) is a brief neurological dysfunction without acute infarction, often preceding ischemic stroke. Although tools like the ABCD2 score aid early risk stratification, their predictive reliability is limited in emergency settings, creating a demand for new biomarkers. Nardilysin (NRDC) and neurogranin (Ng) have emerged as promising candidates due to their involvement in axonal maturation, synaptic plasticity, and neurorepair. However, their diagnostic utility in early TIA remains unclear. This prospective cohort study aimed to evaluate the association between serum NRDC and Ng levels and early outcomes in TIA. We hypothesized that these biomarkers, particularly NRDC due to its neurovascular repair function, could serve as early indicators in patients at risk. A total of 33 TIA patients (20 males; mean age: 65.97 ± 15.99) and 48 healthy controls (23 males; mean age: 66.85 ± 9.53) were recruited from the emergency department of a university-affiliated tertiary hospital in Ankara, Türkiye, between June and December 2022. Groups were similar in age, sex, and body mass index. The control group had no known comorbidities such as hypertension or diabetes. Blood samples were collected within 6 hours of symptom onset and analyzed using ELISA. Clinical variables, ABCD2 scores, and outcomes (e.g., admission, discharge, 1-month mortality) were recorded. Statistical analysis included t-tests, chi-square, Mann-Whitney U, and receiver operating characteristic analysis using SPSS and Analyse-it. NRDC levels were significantly lower in TIA patients (4.65 ± 2.01 pg/mL) than in controls (6.39 ± 2.32 pg/mL, P = .001), showing moderate diagnostic accuracy (AUC = 0.720). Ng levels did not significantly differ between groups (P = .5), and ABCD2 scores showed no correlation with either biomarker. NRDC may be a promising early blood-based biomarker for TIA, particularly when imaging is inconclusive. Further studies are needed to validate these findings and clarify Ng's role.