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We aimed to determine the levels of ubiquitin C-terminal hydrolase-L1 (UCH-L1) in patients admitted to the emergency department with impaired consciousness due to metabolic or neurological reasons.The study included 80 patients with ischemic stroke (IS), 40 patients with intracranial hemorrhage (ICH), 80 patients with metabolic disorder induced impaired consciousness (MDIC) and 40 healthy controls.The levels of UCH-L1 [median (IQR)] were as follows: 5.59 ng/mL (3.90–9.37) in IS, 5.44 ng/ml (4.01–13.98) in ICH, 3.34 ng/ml (2.29–5.88) in MDIC and 3.94 ng/ml (3.31–7.95) in healthy volunteers. Significantly higher levels were detected in IS and ICH than in MDIC and healthy volunteers. In ROC curve analysis, we detected 63.75% sensitivity and 62.5% specificity (AUC = 0.626, p < 0.0199, 95% CI: 0.533–0.713) with a cutoff value of 4.336 ng/ml for IS and 75% sensitivity and 55% specificity (AUC = 0.664, p < 0.0071, 95% CI: 0.549–0.766) with a cut-off value of 4.036 ng/ml for ICH. However, the sensitivity and specificity for MDIC was 36.25% and 77.5%, respectively, with a cut-off value of 3.256 ng/ml (AUC = 0.525, p = 0.6521, 95% CI: 0.432–0.617). UCH-L1 levels were found to increase significantly with increasing time between the onset of symptoms and blood sampling (r = 0.345, p < 0.001). However, no correlation was found between UCH-L1 levels and age (r = 0.014, p = 0.833), GCS (r = −0.115, p = 0.074), mRS (r = 0.063, p = 0.475) and NIHSS (r = 0.056, p = 0.520).In this study, we detected significantly higher levels of UCH-L1 in patients with IS and ICH compared to patients with MDIC and healthy volunteers.