The Role of VEGF, NLR, PLR, and LMR as Biomarkers for Diagnosis and Outcome Prediction in Acute Ischemic Stroke: A ROC Curve Study

Acute ischemic stroke is a leading cause of global morbidity and mortality, and simple hematological inflammatory biomarkers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), along with angiogenic factors such as Vascular Endothelial Growth Factor (VEGF), are considered to have diagnostic and prognostic potential. This cross-sectional observational study was conducted on 50 patients with acute ischemic stroke at Dr. Wahidin Sudirohusodo General Hospital Makassar, where serum VEGF levels were measured using ELISA, while NLR, PLR, and LMR were calculated from routine blood counts, and stroke severity was assessed using the NIHSS. Significant correlations were observed between VEGF and NIHSS (r=0.831; p<0.001), NLR and NIHSS (r=0.548; p<0.001), and LMR and NIHSS (r=−0.549; p<0.001), whereas PLR showed no significant association (r=0.228; p=0.112). ROC analysis further demonstrated that VEGF (AUC=0.984) and NLR (AUC=0.806) were the strongest predictors of stroke severity, while LMR also showed good discriminatory power (AUC=0.801), in contrast to the limited value of PLR. These findings suggest that VEGF, NLR, and LMR may serve as significant biomarkers for diagnosis and outcome prediction in acute ischemic stroke.