The Relationship Between Hs-CRP Levels And The Short-Term Prognosis After Acute Ischemic Stroke

Objective: To determine the prognostic value of hs-CRP levels obtainedwithin72hours of symptom onset in patients with functional disability afteracute ischemic stroke.Methods and materials:317consecutive patients who were diagnosedas acute ischemic stroke admitted to the2nd Hospital of HeBei MedicalUniversity from June2011to December2011were recruited in thisprospective observational study. There were21patients lost to follow-up, theremaining296patients were included. The time after the onset of symptoms ofpatients who were included was all within48hours. Data collected from eachpatient were the following: the general data (gender,age,admission bloodpressure,medical history,smoking and alcohol intake status,current use ofanti-platelet or lipid lowering drugs), the severity of neurological deficit(assessed by the nation institutes of health stroke scale,NIHSS),laboratoryparameter (total cholesterol,LDL cholesterol,HDL cholesterol,triglyceride,fibrinogen,blood glucose,hemoglobin,albumin concentration) and the levelof plasma hs-CRP. Strokes were also classified according to the OxfordshireCommunity Stroke Project system (OCSP).The patients were trisected to threegroups according to CRP values: low hs-CRP group (<1.8mg/L), mediumhs-CRP group (1.8-4.5mg/L) and high hs-CRP group (>4.5mg/L). Wetelephoned patients at three months from stroke onset, the functional disabilitywas assessed by (modified Rankin Scale) MRS, poor outcome was defined asa score of more than2on the MRS. We studied the relation between CRPvalues and poor outcome. A multiple logistic regression model was applied toevaluate the relationship between hs-CRP values and the risk of poor outcome,in order to investigate the prognostic value of hs-CRP levels obtained within72hours of symptom onset in patients with functional disability after acute ischemic stroke.Results:1. General data:There were no significant differences in gender (p=0.253) and age(p=0.367) distribution among groups;The high hs-CRP group had a higherproportion of patients with hypertension (83.8%), atrial fibrillation (20.2%)than medium hs-CRP group (68.4%, p=0.008；6.1%, p=0.005) and lowhs-CRP group (61.6%, p=0.001；3%, p<0.001);Meanwhile,the proportion ofpatients with previous stroke/TIA in the high hs-CRP group (28.3%) andmedium hs-CRP group (27.3%) were both significantly higher compared topatients in the low high hs-CRP group (12.1%, p=0.007, p=0.007); There wereno significant differences in a proportion of patients with diabetes mellitus,and coronary heart disease,current use of anti-platelet or lipid loweringdrugs,all kinds of smoking and alcohol intake status among groups (p>0.05);Besides,admission systolic and diastolic blood pressure of patients amonggroups were also no significant differences (p=0.467, p=0.70).2. Stroke subtype:The most common stroke subtype in the low hs-CRP group was LACI(51.5%),compared to the medium hs-CRP group (29.6%, p=0.002) and highhs-CRP group (19.2%, p<0.001),while in the high hs-CRP group the mostcommon subtype was TACI (23.1%),compared to the medium hs-CRP group(8.2%, p=0.006) and low hs-CRP group (1%, p<0.001), there were nosignificant differences in the proportion of PACI and POCI among groups(p=0.335, p=0.648).3. Laboratory parameter:Patients in the high hs-CRP group have higher serum hs-CRP,FIB,CHOL,LDL,GLU levels and WBC than medium and low hs-CRP group(p<0.05); Morever,there was also significant differences in FIB levels andWBC between medium and low hs-CRP group (p<0.05) while CHOL,LDL,GLU levels were no significant differences (p>0.05); Besides, patients in thelow hs-CRP group [(139.4±15.4)g/L)] had higher HGB level than medium [(135.3±16.2g/L), p>0.05] and high hs-CRP group [(133.2±17.9g/l),p<0.05]; There were no significant differences in serum ALB,TG,HDL levelsamong groups (p=0.054, p=0.1, p=0.929).4. Admission NIHSS and MRS at three months from stroke onset:Patients in the high hs-CRP group had higher NIHSS and MRS score (9.8±7.0,2.9±1.7) than medium hs-CRP group (5.9±6.2,1.8±1.6) and lowhs-CRP group (4.4±3.7,1.2±1.3), P<0.05; Morever, patients in the highhs-CRP group had higher NIHSS and MRS score than low CRP group(P<0.05).5. Prevalence of poor outcome:Patients in the high hs-CRP group (41.4%) more often had a pooroutcome than patients in the medium hs-CRP group (24.5%, p=0.012) and lowhs-CRP group (13.1%, p<0.001); However, there were no significantdifferences in prevalence of poor outcome between medium and low CRPgroup (p=0.041).6. The relationship between hs-CRP values and short-term prognosisafter acute ischemic stroke:A multiple logistic regression model was applied to evaluate therelationship between hs-CRP values and the risk of poor outcome. Patients inthe high hs-CRP group exhibited a5.44-fold increased risk of poor outcomecompared with patients in the low hs-CRP group (OR=5.44,95%CI:2.50-11.84), and patients in the medium hs-CRP group exhibited a2.31-foldincreased risk of poor outcome compared with patients in the low hs-CRPgroup (OR=2.31,95%CI:1.08-4.93);The association between hs-CRP andrisk of poor outcome persisted after adjustment for gender,age,admissionblood pressure,medical history,smoking and alcohol intake status,current useof anti-platelet or lipid lowering drugs,stroke subtype and other risk factors ofstroke (high hs-CRP group vs low hs-CRP group, OR=5.26,95%CI:2.53-10.95; medium hs-CRP group vs low hs-CRP group, OR=2.15,95%CI:1.02-4.51).Although the relationship was attenuated after adjustment,prognostic value of hs-CRP was determined, we could conclude that elevated hs-CRP level within72hours of acute ischemic stroke was an independentprognostic factor of poor outcome at3months.Conclusion: Elevated hs-CRP levels within72hours of acute ischemicstroke are independent prognostic factor for poor outcome at3months.