Objective To investigate the relationship between high-density lipoprotein cholesterol/apolipoprotein A1 (HDL-C/APOA1) ratio and neurological function improvement in acute ischemic stroke (IS) patients at discharge.Methods The study focuses on patients with acute IS treated in the department of neurology of the third people's hospital of Chengdu from January, 2019 to June, 2023. Patients were divided into an improvement group (n=162) and a non-improvement group (n=334) based on whether neurological function improved at discharge. The clinical data of subjects that meet the inclusion criteria were collected, and the univariate and multivariate logistic regression analysis were used to identify the factors influencing the improvement of neurological function in patients upon discharge. Based on the results of multiple factor analysis, a nomogram was created and the ROC curve was plotted to analyze the predictive performance of the column line plots model. The accuracy of the model was evaluated using Hosmer-Lemeshow goodness-of-fit test and calibration curves with Bootstrap method (1 000 times), and decision curve analysis (DCA) was plotted to assess the clinical practicality of the model. Results Univariate analysis showed significant differences between the two groups in HDL-C/APOA1 ratio, admission NIHSS score, endovascular thrombectomy, intravenous thrombolysis, and atrial fibrillation (P＜0.05). A total of 496 patients with acute IS were included, of whom 162 had improved neurological function at discharge. Multifactorial Logistic regression showed that the HDL-C/APOA1 ratio, admission NIHSS score, endovascular thrombolysis, and intravenous thrombolysis were associated with neurological function improvement at discharge. The area under the ROC curve of the corresponding predicted nomogram model was 0.72 (P＜0.001, 95% CI: 0.67～0.76), the Hosmer-Lemeshow test result showed that the χ2 was 10.77(P=0.21), the calibration curve showed a significant agreement between the predicted value and the actual value, and the results of DCA showed that the model had a significant net benefit. Conclusion The HDL-C/APOA1 ratio is associated with improved neurological function in patients with acute IS at discharge, which may provide a biomarker as a basis for early assessment and intervention of neurological function recovery in sufferers