To explore the predictive value of serum glial fibrillary acidic protein (GFAP), visual cone like protein 1 (VILIP-1), and ubiquitin carboxy-terminal hydrolase-1 (UCH-L1) levels on the poor prognosis of neurological function in acute cerebral infarction.

The clinical data of 127 patients with acute cerebral infarction (acute cerebral infarction group) who were treated in Xuzhou First People's Hospital from December 2020 to December 2021 were analyzed retrospectively; another 100 patients with physical examination in the same period were collected as the control group. The difference in serum GFAP, UCH-L1, and VILIP-1 levels between the two groups of patients, as well as the difference in serum GFAP, UCH-L1, and VILIP-1 levels in patients with acute cerebral infarction with different cerebral infarction area, degree of neurological deficit, cognitive function, and prognosis were compared by t-test or analysis of variance; Pearson correlation was used to analyze the correlation between GFAP, UCH-L1 and VILIP-1 levels and cerebral infarction area, neurological deficit score, cognitive function score, and prognosis; Logistic regression analysis was used to analyze the influencing factors of poor prognosis by univariate and multivariate regression analysis. The predictive value of the combination of GFAP, UCH-L1 and VILIP-1 on the adverse prognosis was analyzed by the subject operating characteristic (ROC) curve.

The levels of serum GFAP, UCH-L1, and VILIP-1 in the acute cerebral infarction group were higher than those in the control group [(3.73±1.10) ng/L vs (0.61±0.12) ng/L, (0.52±0.13) μg/L vs（0.21±0.08）μg/L,（8.49±1.56）μg/L vs（1.26±0.38）μg/L], the difference was statistically significant (t=31.725, 27.069, 50.366, P＜0.001). The larger the focal area of cerebral infarction and the more serious the degree of nerve defect, the higher the serum GFAP, UCH-L1, and VILIP-1 levels in patients with acute cerebral infarction (F=18.432, 32.148, 7.775, P＜0.001; F=36.994, 38.677, 15.038, P＜0.001), and the serum GFAP UCH-L1, and VILIP-1 levels were significantly higher (t=6.109, 3.351, 3.030, P＜0.001,=0.001,=0.003; t=6.623, 7.288, 6.990, P＜0.001). The levels of serum GFAP, UCH-L1, and VILIP-1 were positively correlated with the area of cerebral infarction, the degree of neurological deficit, cognitive function score, and poor prognosis (r=0.524, 0.432, 0.524, 0.534, P＜0.001). Univariat Logistic regression analysis showed that hypertension, diabetes, hyperlipidemia, cerebral infarction area, degree of nerve defect, cognitive function, serum GFAP, UCH-L1, and VILIP-1 levels were associated with poor prognosis (all P＜0.05). Multivariate Logistic regression analysis showed that the area of cerebral infarction, the degree of nerve defect, cognitive function, serum GFAP, UCH-L1, and VILIP-1 levels were independent risk factors affecting poor prognosis (P＜0.05). The ROC analysis results showed that the AUC predicted by the three indicators combined was 0.887, which was greater than the AUC predicted by GFA, UCH-L1, and VILIP-1 alone (AUC=0.812, 0.719, 0.823), and the sensitivity and specificity of the three indicators combined prediction was 89.12% and 78.35%, respectively which was higher than the sensitivity and specificity of GFAP, UCH-L1, and VILIP-1 alone(81.56%, 67.23%; 71.23%, 71.53%; 82.89%, 65.40%).

Serum GFAP, UCH-L1, and VILIP-1 levels are related to the size of cerebral infarction focus, the degree of neurological deficit, cognitive function and prognosis in patients with acute cerebral infarction, and the combination of the three indexes has high predictive value for poor prognosis in patients with acute cerebral infarction.