Comprehensive Evaluation of Predictive Significance of FABP4 for Long-term Clinical Outcomes After Ischemic Stroke

Fatty acid-binding protein 4 (FABP4) has been reported to be involved in cerebral ischemia injury by modulating neurological function and inflammatory responses. This study aimed to investigate the association between plasma FABP4 levels and long-term, comprehensive clinical outcomes after acute ischemic stroke. Plasma FABP4 levels were measured in 3352 patients with acute ischemic stroke from the Chinese Acute Ischemic Stroke Antihypertensive Trial. Primary outcome was the composite of death and major disability (modified Rankin Scale score ≥ 3); secondary outcomes included major disability, all-cause mortality, stroke-specific mortality, and cardiovascular events. After 24-month follow-up, 790 patients experienced primary outcome, including 502 major disability and 288 all-cause mortality. Compared with the lowest tertile, the highest tertile of FABP4 was associated with primary outcome (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.27-2.00), major disability (OR 1.40, 95% CI 1.09-1.82), all-cause mortality (hazard ratio [HR] 1.58, 95% CI 1.15-2.17), stroke-specific mortality (HR 1.68, 95% CI 1.17-2.40), and cardiovascular events (HR 1.35, 95% CI 1.02-1.80). Adding FABP4 to the basic model with conventional risk factors significantly improved risk reclassification for primary outcome (net reclassification improvement: 24.95%; integrated discrimination index: 0.75%). FABP4 was among the top five important predictors for primary outcome, ranking higher than N-terminal pro-brain natriuretic peptide and other biomarkers. Elevated plasma FABP4 levels were associated with increased risks of a variety of adverse outcomes after ischemic stroke at 24 months, suggesting that FABP4 could serve as a promising biomarker to improve risk stratification for long-term prognosis in ischemic stroke.