BACKGROUND AND AIMS:Different adipokines have been associated with atherosclerotic plaque rupture and cardiovascular events, such as acute ischemic stroke (AIS). However, the potential role of these molecules in post-ischemic brain injury remains largely unknown. METHODS AND METHODS:We performed a sub-study analysis on non-obese patients with first atherothrombotic stroke (n=35) from a recently published prospective cohort. Primary end-point was to investigate the predictive value of serum leptin/adiponectin ratio on neurological recovery at 90-day after AIS. The secondary end-point was the predictive value of serum adipokine levels of clinical and radiological outcomes at a shorter follow up (at day 1 and 7 after AIS). The radiological evaluation included ischemic lesion volume and hemorrhagic transformation (HT). The clinical examination was based on National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS). RESULTS:At day 1 after AIS, serum leptin and leptin/adiponectin ratio were increased and inversely correlated with both radiological and clinical parameters at all follow up time points. Once identified the best cut-off points by receiver operator curve (ROC) analysis, risk analysis showed that higher circulating leptin improved neurological recovery at day 90. In addition, leptin/adiponectin ratio maintained statistical significance after adjustment for age, gender and thrombolysis, also predicting the occurrence of HT in the first 7 days after AIS (adjusted OR 0.15 [95% CI 0.03-0.83); p=0.030]). CONCLUSIONS:Higher leptin/adiponectin ratio at day 1 predicted better neurological outcomes in patients with atherothrombotic AIS and might be potentially useful as a prognostic biomarker of the disease.