Abstract: Objective To explore the relationship between expression levels of secreted phospholipase A2 (sPLA2), ischemic modified albumin (IMA), and ubiquitin carboxy terminal hydrolases L1 (UCH-L1) and poor prognosis in patients with acute cerebral infarction (ACI) and their predictive value. 
Methods A total of 300 patients with ACI admitted to Fengfeng General Hospital of Huabei Medical and Health Group in Handan City, Hebei Province, between January 2021 and January 2023 were randomly selected as research subjects. At 3 months after discharge, the Modified Rankin Scale (mRS) was utilized to evaluate prognosis, and the expression levels of sPLA2, UCH-L1, and IMA were measured. Among them,150 patients were selected based on their order of admission and subsequently categorized according to mRS assessment results. Patients demonstrating favorable outcomes (scores of 0-2) constituted the control group, while those exhibiting unfavorable outcomes (scores of 3-6) formed the research group. Differences in expression levels of sPLA2, UCH-L1, and IMA between the research group and control group were compared using receiver operating characteristic (ROC) curves, to analyze the predictive efficacy of these biomarkers for poor prognosis in ACI patients as well as determining their cutoff values. The remaining cohort of 150 ACI patients was divided into high-expression and low-expression groups for sPLA2, UCH-L1, and IMA based on established cutoff values respectively. Differences in mRS scores among these biomarker groups were then compared. 
Results A total of 80 patients with good prognosis (0-2 points) were included in the control group, and 70 patients with poor prognosis (3-6 points) were included in the research group. Compared with the control group, sPLA2 ［(14.77±3.27) μg/L vs. (9.81±3.09) μg/L］, UCH-L1 ［(0.87±0.23)μg/L vs. (0.56±0.18) μg/L］ and IMA ［(51.15±9.21) kU/L vs. (36.62±8.65) kU/L］ were significantly increased in the research group (t=9.545, 9.247, 9.958, P＜0.001). The area under the curve (AUC) of sPLA2, UCH-L1 and IMA in predicting poor prognosis of ACI patients was 0.842, 0.829 and 0.833, respectively, the sensitivity was 81.43%, 81.43% and 80.00%, respectively, and the specificity was 82.50%, 90.00% and 88.75%, respectively. The low expression of sPLA2, UCH-L1 and IMA was found in 81, 90 and 79 patients, respectively, while the high expression of sPLA2, UCH-L1 and IMA was found in 69, 60 and 71 patients, respectively. Compared with sPLA2, UCH-L1 and IMA high expression groups, the mRS scores of sPLA2 low expression group ［(4.70±1.09) scores vs. (1.27±1.06) scores］, UCH-L1 low expression group ［(4.48±1.33) scores vs. (1.76±1.62) scores］ and IMA low expression group ［(4.56±1.20) scores vs. (1.30±1.18) scores］ were significantly decreased (t=19.425, 11.235, 16.709, P＜0.001). 
Conclusion sPLA2, UCH-L1 and IMA in ACI patients with poor prognosis are significantly increased and closely related. Therefore, sPLA2, UCH-L1 and IMA can be used as sensitive indicators to predict the prognosis of ACI patients. 

Key words: cerebral infarction, secretory phospholipase A2, ischemia modified albumin, ubiquitin carboxy-terminal hydrolase L1