DOI: http://dx.doi.org/10.18203/2349-3933.ijam20161094

High sensitivity C-reactive protein as a prognostic marker in ischaemic and haemorrhagic stroke

Ritesh Lal, Abhishek Gupta, Sunil Kumar Virmani, Vinod Kumar Tyagi, Shruti Sharma

Abstract


Background: Stroke is the leading cause of death worldwide and one of the main causes of long-term disability. Many patients with elevated CRP levels within 72 hours of stroke have an increased risk of death. However, vascular inflammation is more related to high-sensitivity CRP (hsCRP).There is a distinct possibility that elevated hsCRP may be a direct response to the extent of cerebral tissue injury. The aim of this study was to compare the high sensitivity C-reactive protein (hsCRP) level in patients of stroke and assess its utility in predicting the functional outcome.

Methods: A prospective study of 50 patients presenting with a history of focal neurological deficit of acute onset in the form of hemiparesis/hemianaesthesia and having evidence of presence of   infarct/haemorrhage  in CT/MRI  scan of brain and 50 age and sex matched healthy controls was done. In all patients hsCRP levels were measured within 24 hours of presentation. Admission hsCRP levels were then compared to the scandinavian stroke scale scores.

Results: Mean hsCRP levels were significantly higher in patients with stroke than controls. Patients with a good long term outcome had a statistically significant lower hsCRP levels. 8 patients died during follow/hospitalisation. They had higher hsCRP levels than patients who survived. hsCRP levels and scandinavian score showed a significant correlation both with ischemic and haemorrhagic stroke.  

Conclusion: hsCRP can be used as a marker for prognosis in cases with stroke. hsCRP levels are higher in ischemic stroke than in haemorrhagic stroke.


Keywords


Stroke, hsCRP level, Scandinavian stroke scale

Full Text:

PDF

References


Youn CS, Choi SP, Kim SH, Oh SH, Jeong WJ, Kim HJ, et al. Serum highly selective C-reactive protein concentration is associated with the volume of ischaemic tissue in acute ischaemic stroke. Am J Emerg Med. 2012;30:124-8.

Deb P, Sharma S and Hassan KM. Pathophysiologic mechanisms of acute ischaemic stroke. An overview with emphasis on therapeutic significance beyond thrombolysis. Pathophysiology. 2010;17(3):197-218.

Whiteley W, Jackson C, Lewi S, Lowe G, Rumley A, Sandercock P, et al. Association of circulating inflammatory markers with recurrent vascular events after stroke a prospective cohort study. Stroke. 2011;42(1):10-6.

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 ischaemic stroke and mortality in Japanese men from the general population. Atherosclerosis. 2009;204:2348.

Den Hertog HM, Van Rossum JA, Van der Worp HB, Van Gemert HMA, 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;256(12):2003-8.

Windgassen EB, Funtowicz L, Lunsford TN, Harris LA, Mulvagh S. C-reactive protein and high-sensitivity C-reactive protein: an update for clinicians. Postgrad Med. 2011;123(1):114-9.

Calabro P, Golia E, Yeh E. Role of C-reactive protein in acute myocardial infarction and stroke: possible therapeutic approaches. Curr Pharm Biotechnol. 2012;13(1):4-16.

Di Napoli M, Papa F, Bocola V. C-reactive protein in ischemic stroke: an independent prognostic factor. Stroke. 2001;32(4):917-24.

Muir KW, Weir CJ, Alwan W, Squire IB, Lees KR. C-reactive protein and outcome after ischaemic stroke. Stroke. 1999;30:981-5.

Elkind MS, Tai W, Coates K, Paik MC, Sacco RL. High-sensitivity C-reactive protein, lipoprotein-associated phospholipase A2, and outcome after ischaemic stroke. Arch Intern Med. 2006;166(19):2073-80.

Roudbary SA, Saadat F, Forghanparast K, Sohrabnejad R. Serum C-reactive protein level as a biomarker for differentiation of ischemic from haemorrhagic stroke. Acta Med Iran. 2011;49(3):149-52.

Talreja P, Chandra R, Saxena SK, Verma S, Jain R, Bhuyan A. High Sensitivity C - reactive protein (hsCRP) level in cerebrovascular accident (Stroke). JIACM. 2010;11(3):204-7.

Teasdale G, Murray G, Parker L, Jennett B. Adding up the GCS. Acta Neurochir Suppl (wien). 1979; 28(1):13-6.

Burtin P, Bollaert PE, Feldmann L. Prognosis of patients with stroke undergoing mechanical ventilation. Intensive Care Med. 1994;20:32-6s.

Idicula TT, Brogger J, Naess H, Waje Andreassen U, Thomassen L. Admission C reactive protein after acute ischaemic stroke is associated with stroke severity and mortality: The Bergen stroke study. BMC Neurology. 2009;9:18.

Rost NS, Wolf PA, Kase CS, Kelly Hayes M, Silbershatz H, Massaro JM, et al. Plasma concentration of C reactive protein and risk of ischaemic stroke and TIA: the Framingham Study. Stroke. 2011;32:2575-79.

Arenillas JF, Alvarez-Sabin J, Molina CA, Chacon P, Montaner J, Rovira A, et al. C-reactive protein predicts further ischemic events in first-ever transient ischemic attack or stroke patients with intracranial large-artery occlusive disease. Stroke. 2003;34:2463-8.

Eikelboom JW, Hankey GJ, Baker RI, McQuillan A, Thom J, Staton J, et al. C-reactive protein in ischaemic stroke and its aetiologic subtypes. J Stroke Cerebrovasc Dis. 2003;12:74-81.

Winbeck K, Poppert H, Etgen T, Conrad B, Sander D. Prognostic relevance of early serial C Reactive protein measurements after first ischaemic stroke. Stroke. 2002;33:2459-64.

Napoli MD, Elkind SV, Wagner AP. Role of C reactive Protein in Cerebrovascular stroke. Expert Rev Cardiovasc Ther. 2014;9(12):1565-84.