Objective To investigate the relationship between serum neutrophil elastase(NE),Sortilin and carotid atherosclerotic(CAS)plaque in patients with acute cerebral infarction(ACI)and its predictive value for poor prognosis.Methods A total of 155 patients with ACI admitted to Daxing Teaching Hospital of Cap-ital Medical University from December 2020 to November 2022 were selected as the study objects.According to carotid intima-media thickness(IMT),they were divided into normal IMT group,thickened group and plaque group,and 40 healthy subjects were selected as control group during the same period.The serum levels of NE and Sortilin in all groups were compared and their correlations with IMT were analyzed.ACI patients were followed up for 3 months and divided into good prognosis group and poor prognosis group.Serum NE and Sortilin levels were compared between the two groups.Multivariate Logistic regression was used to ana-lyze the risk factors of poor prognosis in ACI patients.Receiver operating characteristic(ROC)curve was used to predict prognosis.Results The levels of serum NE and Sortilin in control group,IMT normal group,thick-ened group and plaque group were increased successively(P<0.05).Pearson correlation analysis showed that serum NE and Sortilin levels were positively correlated with IMT(r=0.509,0.483,P<0.05).The incidence of poor prognosis in ACI patients was 39.35%.The proportion of diabetes mellitus,age,admission National Institutes of Health Stroke Scale(NIHSS)score,low density lipoprotein cholesterol,total cholesterol,fasting blood glucose,white blood cell count,serum creatinine,NE,uric acid(UA)and Sortilin levels in poor progno-sis group were higher than those in good prognosis group(P<0.05).Multivariate Logistic regression analysis showed that admission NIHSS score and UA,NE and Sortilin levels were independent risk factors for poor prognosis in ACI patients(P<0.05).ROC curve analysis showed that the area under the curve of serum NE,Sortilin and UA alone and combined to predict poor prognosis were 0.695,0.740,0.752 and 0.869,respective-ly.The combined prediction efficiency of serum NE,Sortilin and UA was higher than that of single detection of each indicator.Conclusion The increase of serum NE and Sortilin levels in ACI patients is positively corre-lated with CAS,and is an independent risk factor for poor prognosis in ACI patients.Detection of serum NE and Sortilin levels could help predict the short-term prognosis of ACI patients.