ABSTRACT NUMBER: ESOC2026A1059 GLUTATHIONE S-TRANSFERASE ALPHA 4 AS A NOVEL BIOMARKER FOR ACUTE ISCHAEMIC STROKE: ASSOCIATION WITH DISEASE PROGRESSION AND PROGNOSIS

Abstract Background and aims Given the role of oxidative stress in acute ischaemic stroke (AIS), the aim of this study was to investigate the association between serum glutathione s-transferase alpha 4 (Gsta4), a brain-abundant detoxification enzyme, and AIS progression and prognosis. Methods This prospective cohort study measured serum Gsta4 expression at admission in 188 consecutive patients with acute ischaemic stroke (AIS) and 63 community-based non-stroke controls using an enzyme-linked immunosorbent assay (ELISA). Associations of Gsta4 with stroke progression (assessed using the National Institutes of Health Stroke Scale [NIHSS]), three-month functional outcomes (evaluated by the modified Rankin Scale [mRS]), and prognosis were analysed using multivariable-adjusted logistic regression and restricted cubic spline models. The incremental prognostic value of Gsta4 expression was further quantified using the net reclassification index (NRI), integrated discrimination improvement (IDI), and receiver operating characteristic (ROC) curves. Results Serum expression of Gsta4 was significantly elevated in AIS patients compared to controls. After adjusting for conventional confounders, a higher serum Gsta4 level was significantly and independently associated with an increased risk of neurological progression and an unfavourable three-month outcome. This association was linear for neurological progression and poor prognosis, respectively. Furthermore, integrating Gsta4 expression into existing risk models greatly improved risk reclassification and predictive precision for both endpoints. Conclusions Serum Gsta4 expression serves as an independent predictor for AIS and provides incremental value compared to conventional risk factors for enhancing the prediction of disease progression and clinical outcomes. Conflict of interest Hailong Yu , Yongxin Yuan,Aipeng Hu,Luhang Tao, Jing Hang, Xin Chen，Xiaoyun Huang, Ran Zhang, Li Dong,nothing to disclose