Clinical severity and outcome in association with hsCRP levels in acute ischemic stroke

INTRODUCTION : There is growing evidence that C-reactive protein (CRP), a peripheral marker of inflammation, is also a marker of generalized atherosclerosis. This relationship between inflammation and atherosclerosis make CRP a potential marker for prognosis after vascular events and a potential predictor of future vascular events. Acute phase proteins have been implicated to play roles both during acute and chronic inflammatory processes in different diseases including ischemic stroke The onset of cerebral ischaemia triggers a cascade of pro-inflammatory molecular and cellular events. Clinical studies suggest that the strength of this acute response is important in early and late clinical outcomes, early clinical worsening, and extent of brain damage. Variables that are predictors of adverse stroke outcome include erythrocyte sedimentation rate, and levels of C-reactive protein (CRP), interleukin-6, tumour necrosis factor-α and intercellular adhesion molecule-1. Current data indicate that inflammation serves to fuel atherosclerosis and can act as the link between atherosclerosis and atherothrombosis. Inflammatory factors play an important role in the pathogenesis of ischemic stroke. Acute phase proteins level such as a fibrinogen, CRP, ferritin increase after acute ischemic stroke. These findings support a possible role of an inflammatory stimulus in the acute ischemic stroke. The WHO has recently set international reference standard for the use of highly sensitive CRP assays. This has enhanced the usefulness of CRP as a reliable predictor of cardiovascular events. AIM : 1. To predict the functional outcome of acute ischemic stroke in relation with hsCRP levels after 30 days. 2. To assess severity of stroke in association with hsCRP levels. 3. To determine its association with other risk factors. MATERIALS AND METHODS : Setting: Medical ward, K.A.P.V.Govt. Medical College, AGM. Govt. Hospital, Trichy. Study design: Prospective hospital based study. Period of study: January 2010 to Oct 2010. Inclusion criteria : 1. All patients who presented within 48 hours of onset of stroke and who gave informed consent to participate in the study were included. EXCLUSION CRITERIA : 1. Hemorrhagic stroke, 2. Age > 70 yrs, 3. NSAID INTAKE, 4. Connective tissue disorder/arthritis, 5. Recurrent stroke, 6. Active infections, 7. Ischaemic heart disease/ Coronary heart disease. Study method: A total of 50 patients who presented with acute ischemic stroke were enrolled into the study. That the stroke was an ischemic one was confirmed by CT scan. As soon as the patients were admitted within 48 hours of onset of stroke, serum samples were taken for hs-CRP estimation. Serum hs-CRP levels were also estimated in fifty normal patients (without any evidence of acute infection, neoplasm, rheumatic heart disease, collagen vascular disease, hypertension, DM, IHD) and was found to be within normal limits. Standard guidelines for the treatment of acute ischemic stroke were followed. None of the patients received any thrombolytic treatment. CRP and NIH stroke scale (NIHSS) were measured at the time of admission. Short-term functional outcome was measured by modified Rankin scale (mRS) and 30 days after admission. CONCLUSION : Patients with elevated hs-CRP had a poorer outcome when compared to patients with lower levels of CRP, 30 days after the onset of ischemic stroke. Patients with elevated hs-CRP had a poor admission NIH stroke score>7. • hs-CRP levels showed no significant correlation in patients with high blood pressure. • hs-CRP levels had no significant correlation with age or gender. • hs-CRP did not show a statistically significant correlation with smoking or cholesterol intake. • There was no statistically significant correlation between hs-CRP levels and those with diabetes. • hs-CRP is 100% sensitive and 86.14% specific as a prognostic tool in acute ischemic stroke. hs-CRP has a diagnostic accuracy of 94% in patients with acute ischemic stroke