Adipocyte fatty acid-binding protein (FABP4) played critical roles in metabolic syndrome, inflammatory responses and cardiovascular diseases. It aimed to investigate the associations of serum FABP4 levels with early stroke recurrence. This study included the 206 acute ischemic stroke patients hospitalized in our institution. Stroke recurrence events were assessed at the 3-month follow-up. The median of FABP level was 22.6 (IQR, 17.9-31.6) ng/mL in patients with stroke recurrence (N=36), which was higher than in patients without stroke recurrence [16.9 (IQR, 11.8-21.4) ng/mL] (P<0.001). As a continuous variable, the unadjusted and adjusted risk of stroke recurrence would be increased by 12% (OR=1.12 [95% CI 1.06-1.17], P<0.001) and 8% (1.08 [1.02-1.14], P=0.006) for every 1 ng/ml increment of FABP4. The Area under the curve (AUC) of serum FABP4 and NIH Stroke Scale (NIHSS) score for predicting stroke recurrence was 0.73 (95% CI: 0.64-0.82) and 0.72 (95% CI: 0.64-0.81), presenting no discriminating capacity (P=0.45). In the combining model, the AUC of NIHSS score was further improved to 0.77 by FABP4 (0.77; 95% CI: 0.69-0.85), which was significant (P=0.01). The risk of stroke recurrence can be predicted by elevated FABP4 levels in serum of nondiabetic patients with first-ever ischemic stroke.