Incorporating TPM4 into the basic model significantly improved the predictive power for poor functional outcomes (net reclassification index: 31.87%, <i>p</i> = 0.041; integrated discrimination improvement: 5.01%, <i>p</i> = 0.008; Brier score decreased from 0.16 to 0.15, <i>p</i> = 0.012).<h4>Conclusions</h4>Lower serum TPM4 levels on admission were independently associated with poor functional outcomes at 1 year in AIS patients, suggesting that TPM4 may serve as a potential biomarker for long-term outcomes and offer insights into its potential role in stroke pathophysiology. The gene discussed is TPM4; the disease is androgen insensitivity syndrome.