Prognostic significance of hs-CRP in acute ischemic stroke patients
Keywords:Acute ischemic stroke, hs CRP, National Institute of Health Stroke Scale
Background: Stroke, a serious neurological disease is a major cause of death and disability throughout world. The pathophysiology of stroke involves inflammatory pathways, oxidative damage, apoptosis, angiogenesis and neuroprotection. High sensitivity C - reactive protein (hs-CRP) is associated with atherosclerosis and predict incident stroke in many patients. Objective of present study was to find out change in pattern of hs-CRP in acute ischemic stroke (AIS) patients during 3-months follow up and its prognostic significance.
Methods: Single centre prospective cross-sectional time bound study. 256 were screened and 130 meet the inclusion and exclusion criteria, of which 100 gave informed consent and 80 patients completed the study at 3 months. Demographic, clinical parameters including NIHSS scoring, biochemical analysis was collected at enrolment, discharge and at end of the study.
Results: hs-CRP levels in AIS increased significantly (within 24 hours of stroke) and continued to increase further at discharge, while decreased significantly during 3 months follow up. >7mg/dl hs-CRP at admission had 3.5 fold higher risk of mortality. Age >60 years, metabolic syndrome, hyperlipidemic, SBP >160mmHg and hs-CRP > 7 mg/dL increases relative risk in AIS stroke patients by 1.42, 1.09, 1.11, 1.577 and 3.23 fold respectively.
Conclusions: hs-CRP increased significantly in AIS patients during 1st weeks of stroke with subsequent gradual decrease by the end of 3 months, the severity scoring system could determine prognosis on admission to ICU while hs-CRP is the main factor determining short as well as long term prognosis. We recommend serial measurements of hs-CRP for prognostication in AIS subjects.
Youn CS, Choi SP, Kim SH, Oh SH, Jeong WJ, Kim HJ, Park KN. Serum highly selective C-reactive protein concentration is associated with the volume of ischemic tissue in acute ischemic stroke. Am J Emerg Med. 2012 Jan 1;30(1):124-8.
Deb P, Sharma S, Hassan KM. Pathophysiologic Mechanisms of acute ischemic stroke. An overview with emphasis on therapeutic significance beyond thrombolysis. Pathophysiology. 2010;17(3):197-218.
Whiteley W, Jackson C, Lewis S, Lowe G, Rumley A, Sandercock P et al. Inflammatory markers and poor outcome after stroke: a prospective cohort study and systematic review of interleukin-6. PLoS medicine. 2009 Sep 8;6(9):e1000145..
Makita S, Nakamura M, Satoh K, Tanaka F, Onoda T, Kawamura K et al. Serum C-reactive protein levels can be used to predict future ischemic stroke and mortality in Japanese men from the general population. Atherosclerosis. 2009 May 1;204(1):234-8.
Den Hertog HM, Van Rossum JA, Van der Worp HB, Van Gemert HM, de Jonge R, Koudstaal PJ, et al. C-reactive protein in the very early phase of acute ischemic stroke: association with poor outcome and death. J Neurol. 2009 Dec 1;256(12):2003-8.
Napoli MD, Elkind MSV, Wagner AP. Role of C-reactive Protein in Cerebrovascular stroke . Expert Rev Cardiovasc Ther. 2011;9(12):1565-184.
NIH Stroke Scale Training, Part 2. Basic Instruction. Department of Health and Human Services, National Institute of Neurological Disorders and Stroke. The National Institute of Neurological Disorders and Stroke (NINDS) Version 2.0.
Whiteley W, Chong WL, Sengupta A, Sandercock P. Blood markers for the prognosis of ischemic stroke: a systematic review. Stroke. 2009 May 1;40(5):e380-9.
Corso G, Bottacchi E, Brusa A, Benedetto MD, Giardini G, Lia C, Reggiani M, Veronese Morosini M. Is there a prognostic role for C‐reactive protein in ischemic stroke?. Acta Neurologica Scandinavica. 2010 Sep 1;122(3):209-16.
Elkind MSV, Luna JM, Moon YP. High-sensitivity Creactive protein (hs CRP) predict stroke, vascular events, and mortality in a prospective cohort study. Neurology. 2009;73:1300-7.
Huang Y, Jing J, Zhao XQ, Wang CX, Wang YL, Liu GF, Wang CJ et al. High‐Sensitivity C‐Reactive Protein is a Strong Risk Factor for Death after Acute Ischemic Stroke among Chinese. CNS Neurosci Therapeu. 2012 Mar 1;18(3):261-6.
Libby P. Inflammation in atherosclerosis. Nature 2002;420:868-74.
Mahapatra RC. C reactive protein in thrombotic stroke. JAPI. 2002;50:1512.
Arevalo-Lorido JC, Carretero-Gomez J, Calvo-Romero JM, Romero-Requena JM, Perez-Alonso JL, Gutierrez-Montano C. et al; C Reactive Protein in the acute phase of ischemic stroke. Med Clin (Barc). 2005;125(20);766-9.
Masotti L, Ceccarelli E, Forconi S, Cappelli R. Prognostic role of C‐reactive protein in very old patients with acute ischaemic stroke. J Internal Med. 2005 Aug 1;258(2):145-52.
Muir KW, Weir CJ, Alwan W, Squire IB, Lees KR. C reactive protein and out come after ischaemic stroke. Stroke. 1999;30:981-5.
Johnston KC, Li JY, Lyden PD, Hanson SK, Feasby TE, Adams R, et al. Medical and neurological complications of ischemic stroke: experience from the RANTTAS trial. Stroke. 1999;29:447-53.
Langhorne P, Stott DJ, Robertson L, MacDonald J, Jones L, McAlpine C. Medical complications after stroke: a multicenter study. Stroke. 2000;31:1223-9.