ABSTRACT NUMBER: ESOC2026A479 SERUM MEPRINΒ PREDICTS EARLY PROGRESSION AND LONG-TERM PROGNOSIS IN ACUTE ISCHEMIC STROKE: A PROSPECTIVE COHORT STUDY

Abstract Background and aims Postischaemic neuroinflammation drives cerebral injury after stroke. Meprinβ, a zinc metalloprotease abundantly expressed in the brain parenchyma, activates proinflammatory mediators and amplifies blood–brain barrier disruption. We hypothesised that serum meprinβ reflects acute ischaemic stroke (AIS) early progression, and long-term outcomes. Methods In this prospective cohort, serum levels of meprinβ were measured at admission in AIS patients and nonstroke controls. Stroke severity was graded with the National Institute of Health Stroke Scale , and three-month functional outcomes were assessed with the modified Rankin Scale . The association between serum meprinβ level and neurological progression and clinical prognosis was assessed using multivariable-adjusted binary logistic regression and restricted cubic spline models. The incremental predictive utility of adding meprinβ to baseline models was evaluated using the net reclassification index , integrated discrimination improvement , and confusion matrices. Results Compared with controls, AIS patients presented significantly higher serum meprinβ levels. After adjustment for conventional confounders, elevated meprinβ emerged as an independent risk factor for progression and unfavourable three-month outcomes. An elevated serum meprinβ level was associated with an increased risk of both neurological progression and an unfavourable outcome. This relationship was linear for disease progression but nonlinear for poor prognosis. The addition of meprinβ to conventional risk factors significantly improved the risk reclassification and predictive accuracy for both endpoints. Conclusions Serum meprinβ serves as an independent risk factor for both early neurological progression and unfavourable outcomes. Its incorporation significantly enhances the predictive performance of conventional models, supporting its utility as a practical blood-based biomarker for risk stratification of AIS patients. Conflict of interest Hailong Yu , Aipeng Hu,Luhang Tao, Jing Hang, Xin Chen，Xiaoyun Huang, Ran Zhang, Li Dong,Xuetingwen Zhu, nothing to disclose