Objective To investigate the association between the disease severity and prognosis of cerebral infarction patients and serum levels of neuron-specific enolase (NSE), angiopoietin-1 (Ang-1), and angiopoietin-like protein-3 (ANGPTL3).

Methods A total of 510 patients with cerebral infarction admitted to the Department of Neurology, the First People's Hospital of Jiujiang City, Jiangxi Province between February 2022 and May 2024 were enrolled. According to their disease severity, the patients were divided into a mild group (n = 192), a moderate group (n = 215), and a severe group (n = 103). After treatment, the patients were further divided into a good prognosis group (n = 384) and a poor prognosis group (n = 126). During the same period, 121 healthy individuals were included as a control group. During the same period, 121 healthy individuals were included in a control group. Serum levels of NSE, Ang-1, and ANGPTL3 of all patients were measured upon admission. The correlations between these biomarkers and disease severity were analyzed. The predictive value of each biomarker alone and that of the 3 biomarkers in combination for poor prognosis in patients with cerebral infarction were assessed using receiver operating characteristic (ROC) curves.

Results Serum NSE and ANGPTL3 levels in the severe group were significantly higher than those in the moderate and mild groups, whereas the serum Ang-1 levels in the severe group were significantly lower than those in the moderate and mild groups (all P < 0.05). Spearman correlation analysis showed that serum NSE and ANGPTL3 levels were positively correlated with disease severity (r = 0.179 and 0.313, respectively, P < 0.05), while serum Ang-1 levels were negatively correlated with disease severity (r = －0.187, P < 0.05). Prognostic analysis revealed that serum NSE and ANGPTL3 levels were higher, while serum Ang-1 levels were lower, in the poor prognosis group compared with the good prognosis group (all P < 0.05). Multivariate logistic regression revealed that serum levels of NSE (odds ratio OR = 1.228, 95% CI: 1.146-1.316), Ang-1 (OR = 0.059, 95% CI: 0.020-0.178), and ANGPTL3 (OR = 1.334, 95% CI: 1.256-1.417) were major factors associated with prognosis in patients with cerebral infarction (all P < 0.05). ROC curves showed that serum NSE, Ang-1, and ANGPTL3 levels in combination yielded an area under the curve (AUC) of 0.904 (95% CI: 0.871-0.936), with a sensitivity of 79.40% and a specificity of 89.60%. The Hosmer–Lemeshow test of the model showed a good predictive performance (χ² = 7.423, P = 0.492).

Conclusion The severity and prognosis of cerebral infarction patients are strongly correlated with high serum NSE and ANGPTL3 levels and low Ang-1 levels. Monitoring changes in these 3 biomarkers may inform clinical treatment of patients with cerebral infarction.