Objective To investigate the correlations of serum levels of platelet activation complex-1 (PAC-1) and soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) with neurological deficit and clinical prognosis in patients with acute cerebral infarction (ACI).

Methods A total of 170 ACI patients (ACI group) and 85 healthy volunteers (control group) were enrolled in this study. Based on severity of neurological deficit assessed by the National Institutes of Health Stroke Scale (NIHSS) score, ACI patients were divided into of mild neurological deficit group (43 cases), moderate neurological deficit group (57 cases), moderate-to-severe neurological deficit group (37 cases), and severe neurological deficit group (33 cases). Additionally, based on the 6-month follow-up prognosis, ACI patients were divided into 51 cases of poor prognosis group and 119 cases of good prognosis group. Enzyme-linked immunosorbent assay was used to measure serum levels of PAC-1 and sTWEAK. Spearman correlation analysis was performed to evaluate their correlations with NIHSS scores in ACI patients. Multivariate unconditional Logistic regression analysis was conducted to determine their relationships with clinical prognosis. Receiver operating characteristic curves were used to explore their evaluation efficacy for poor clinical prognosis.

Results Serum levels of PAC-1 and sTWEAK were significantly higher in the ACI group than in the control group (P < 0.05). Serum levels of PAC-1 and sTWEAK increased sequentially in the mild, moderate, moderate-to-severe, and severe neurological deficit groups (P < 0.05). Spearman correlation analysis showed that serum levels of PAC-1 and sTWEAK were positively correlated with NIHSS scores in ACI patients (r_s=0.715 and 0.706, respectively; P < 0.001). Multivariate unconditional Logistic regression analysis revealed that older age, higher NIHSS score, larger infarct volume, higher PAC-1 level, and higher sTWEAK level were independent risk factors for poor prognosis in ACI patients (P < 0.05). The area under the curve for the combined assessment of serum PAC-1 and sTWEAK levels for poor clinical prognosis in ACI patients was 0.895, which was greater than the areas under the curve for the individual assessments (0.792 and 0.786, respectively; P < 0.05).

Conclusion Elevated serum levels of PAC-1 and sTWEAK are closely related to increased neurological deficit and poor clinical prognosis in ACI patients. The combined detection of these two markers has high evaluation efficacy for clinical prognosis in ACI patients.