TNF-α in acute ischemic stroke: a pilot study of early inflammatory changes and clinical associations

Introduction: Tumor necrosis factor-alpha (TNF-α) is a pro-inflammatory cytokine implicated in ischemic tissue injury and immune activation. However, its early circulating profile and associations with clinical and laboratory parameters in acute ischemic stroke (AIS) remain incompletely characterized. This pilot study investigated TNF-α levels at admission and 24 hours after intravenous thrombolysis (IVT), compared with healthy controls, and explored correlations with clinical and laboratory variables. Methods: Fifteen patients with AIS were assessed. TNF-α concentrations were measured at admission and 24 hours after IVT and compared with those in age- and sex-matched healthy controls. Correlations between TNF-α, biochemical and hematological parameters, and neurological severity assessed by the National Institutes of Health Stroke Scale (NIHSS) were evaluated using Spearman’s rank correlation. Results: TNF-α levels were significantly elevated in patients with AIS compared with healthy controls, whereas no significant difference was observed between admission and 24-hour post IVT measurements. TNF-α correlated positively with triglycerides (ρ = 0.600) and bleeding time (ρ = 0.617), and negatively with creatinine (ρ = −0.834). NIHSS correlated positively with the platelet-to-lymphocyte ratio (PLR; ρ = 0.572) and negatively with the absolute monocyte count (ρ = −0.570). Conclusion: This pilot study identified elevated circulating TNF-α in AIS without a detectable change at 24 hours after IVT. Exploratory correlations linked inflammatory, metabolic, hematological, and clinical parameters. These preliminary findings require validation in larger cohorts.