Abstract
Objective
To test the hypothesis that pre-treatment Creactive protein (CRP) predicts outcome in stroke patients undergoing intravenous thrombolysis (IVT) treatment.
Methods
We analyzed the data of 111 consecutive patients with IVT within 6 hours of stroke onset for stroke involving the middle cerebral artery territory and admission CRP ≤ 6 mg/dl.
Results
CRP levels were consistently, yet non-significantly lower in patients with unfavourable outcome definitions. Median (range) CRP levels were 0.3 (0–5.9) mg/dl vs. 0.4 (0–5.7) mg/dl (p = 0.13) in patients dependent or dead after 3 months (modified Rankin Scale score > 2; n = 59) vs. independent patients (n = 52); 0.2 (0.1–1.5) mg/dl vs. 0.4 (0–5.9) mg/dl (p = 0.28) in patients dead after 3 months (n = 14) versus survivors (n = 97); and 0.2 (0.1–0.7) mg/dl vs. 0.4 (0–5.9) mg/dl (p = 0.09) in patients with significant neurological deterioration within 24 hours (increase in ≥ 4 points on National Institute of Health Stroke scale; n = 9) vs. patients without early deterioration (n = 102). Independent predictors of dependency/death after 3 months, identified by multivariate logistic regression analyses, were baseline NIHSS score (OR = 1.31, 95 % CI 1.16–1.48, p < 0.001), time from onset to treatment (OR = 1.01, 95 % CI 1.0–1.02, p = 0.024), and presence of diabetes (OR = 8.16, 95 % CI 1.18–56.5, p = 0.033).
Conclusion
Pre-treatment CRP clearly failed to predict outcome in stroke patients treated with IVT. Our findings contradict previously published work and highlight the need for further research on this topic.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Audebert HJ, Rott MM, Eck T, Haberl RL (2004) Systemic inflammatory response depends on initial stroke severity but is attenuated by successful thrombolysis. Stroke 35:2128–2133
Ben-Assayag E, Shenhar-Tsarfaty S, Bova I, et al. (2007) Triggered C-reactive protein (CRP) concentrations and the CRP gene –717A>G polymorphism in acute stroke or transient ischemic attack. Eur J Neurol 14:315–320
Brott T, HP Adams HP, Olinger CP, et al. (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870
Christensen H, Boysen G (2004) C-reactive protein and white blood cell count increases in the first 24 hours after acute stroke. Cerebrovasc Dis 18:214–219
Di Napoli M, Papa F (2003) Clinical use of C-reactive protein for prognostic stratification in ischemic stroke: has the time come for including it in the patient risk profile? Stroke 34:375–376
Di Napoli M, Papa F, Bocola V (2001) C-reactive protein in ischemic stroke: an independent prognostic factor. Stroke 32:917–924
Jialal I, Stein D, Balis D, Grundy SM, Adams-Huet B, Devaraj S (2001) Effect of hydroxymethyl glutaryl coenzyme a reductase inhibitor therapy on high sensitive C-reactive protein levels. Circulation 103:1933–1935
Kane I, Sandercock P, Wardlaw J (2007) Magnetic resonance perfusion diffusion mismatch and thrombolysis in acute ischaemic stroke: a systematic review of the evidence to date. J Neurol Neurosurg Psychiatry 78:485–490
Kent DM, Selker HP, Ruthazer R, Bluhmki E, Hacke W (2006) The stroke-thrombolytic predictive instrument. A predictive instrument for intravenous thrombolysis in acute ischemic stroke. Stroke 37:2957–2962
Kent DM, Selker HP, Ruthazer R, Bluhmki E, Hacke W (2006) The stroke-thrombolytic predictive instrument. Can multivariable risk-benefit profiling be used to select treatmentfavorable patients for thrombolysis in stroke in the 3- to 6-hour time window? Stroke 37:2963–2969
Marquardt L, Ruf A, Mansmann U, et al. (2005) Inflammatory response after acute ischemic stroke. J Neurol Sci 236:65–71
Montaner J, Fernandez-Cadenas I, Molina CA, et al. (2006) Poststroke Creactive protein is a powerful prognostic tool among candidates for thrombolysis. Stroke 37:1205–1210
Muir KW, Weir CJ, Alwan W, Squire IB, Lees KR (1999) C-reactive protein and outcome after ischemic stroke. Stroke 30:981–985
Nilupul Perera M, Ma HK, Arakawa S, et al. (2006) Inflammation following stroke. J Clin Neurosci 13:1–8
Pepys MB, Hirschfield GM, Tennent GA, et al. (2006) Targeting C-reactive protein for the treatment of cardiovascular disease. Nature 440:1217–1221
Rallidis LS, Vikelis M, Panagiotakos DB, et al. (2006) Inflammatory markers and in-hospital mortality in acute ischaemic stroke. Atherosclerosis 189:193–197
Samson Y, Lapergue B, Hosseini H (2005) Inflammation and ischaemic stroke: current status and future perspectives. Rev Neurol 61:1177–1182
Singh U, Devaraj S, Jialal I (2005) C-reactive protein decreases tissue plasminogen activator acitivity in human endothelial aortic cells: evidence that C-reactive protein is a procoagulant. Arterioscler Thromb Vasc Biol 25:2216–2221
SITS-MOST Study Protocol (2007) http://www.acutestroke.org/index.php? module=ContentExpress&func=displa y&ceid=26&meid=6# Last accessed on 3 December 2007
Smith CJ, Emsley HC, Vail A, et al. (2006) Variability of the systemic acute phase response after ischemic stroke. J Neurol Sci 251:77–81
Sobesky J, Frackowiak M, Zaro Weber O, et al. (2007) The Cologne stroke experience: safety and outcome in 450 patients treated with intravenous thrombolysis. Cerebrovasc Dis 24:56–65
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587
The ATLANTIS, ECASS, and NINDS rt-PA Study Group Investigators (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363:768–774
Thomalla G, Schwark C, Sobesky J, et al. (2006) Outcome and symptomatic bleeding complications of intravenous thrombolysis within 6 hours in MRIselected stroke patients. Comparison of a German multicenter study with the pooled data of ATLANTIS, ECASS, and NINDS rt-PA trials. Stroke 37:852–858
Van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607
Verma S, Devaraj S, Jialal I (2006) Is Creactive protein an innocent bystander or proatherogenic culprit? C-reactive protein promotes atherothrombosis. Circulation 113:2135–2150
Vila N, Castillo J, Davalos A, Chamorro A (2000) Proinflammatory cytokines and early neurological worsening in ischemic stroke. Stroke 31:2325–2329
Winbeck K, Poppert H, Etgen T, Conrad B, Sander D (2002) Prognostic relevance of early serial C-reactive protein measurements after first ischemic stroke. Stroke 33:2459–2464
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Topakian, R., Strasak, A.M., Nussbaumer, K. et al. Prognostic value of admission C-reactive protein in stroke patients undergoing IV thrombolysis. J Neurol 255, 1190–1196 (2008). https://doi.org/10.1007/s00415-008-0866-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-008-0866-y