ADMISSION C-REACTIVE PROTEIN AS A PROGNOSTIC BIOMARKER IN ACUTE ISCHEMIC STROKE: A PROSPECTIVE OBSERVATIONAL STUDY
Main Article Content
Keywords
Acute ischemic stroke, C-reactive protein, inflammation, blood pressure, hyperglycemia, prognosis.
Abstract
C-reactive protein (CRP) is a sensitive biomarker of systemic inflammation. Elevated CRP has been implicated in vascular endothelial dysfunction, metabolic derangement, and atherothrombotic disease. Its prognostic significance in acute ischemic stroke (AIS) remains an area of clinical relevance. Despite the known associations between CRP levels and cerebrovascular outcomes, AIS remains underexplored in South Indian populations, where metabolic comorbidities are highly prevalent.
Objectives:
To evaluate the association between admission CRP levels and clinical outcomes in AIS and to examine correlations between CRP, blood pressure, and blood glucose.
Methods:
A prospective observational study was conducted on 100 radiologically confirmed AIS patients at Government Thiruvarur Medical College. Admission CRP, systolic and diastolic blood pressure (SBP, DBP), and blood glucose were recorded. Correlations were analyzed using Pearson’s test, with p < 0.05 considered statistically significant.
Results:
Mean CRP was 18.12 ± 17.79 mg/L, SBP 146.40 ± 38.07 mmHg, DBP 89.50 ± 18.27 mmHg, and glucose 229.88 ± 122.78 mg/dL. Elevated CRP (>6 mg/L) was observed in 89% of patients. CRP correlated negatively with SBP (r = –0.214, p = 0.032) and DBP (r = –0.261, p = 0.009), while correlation with glucose was weak and non-significant (r = 0.044, p = 0.662). Patients with CRP >10 mg/L had a 41.6% mortality rate versus 9.1% in those with normal CRP levels.
Conclusion:
Elevated admission CRP is significantly associated with poor outcomes in AIS. Its significant inverse correlation with blood pressure suggests a hemodynamic–inflammatory interplay that may reflect vascular dysregulation in severe strokes. Integrating CRP testing into early stroke assessment could improve prognostication and guide anti-inflammatory or hemodynamic-targeted therapies
References
2. Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res 2017;120:439–48. https://doi.org/10.1161/ CIRCRESAHA.116.308413; PMID: 28154096.
3. Bejot Y, Bailly H, Durier J, Giroud M. Epidemiology of stroke in Europe and trends for the 21st century. Presse Med 2016;45:e391–8. https://doi.org/10.1016/j.lpm.2016.10.003;
4. Lavados PM, Hennis AJ, Fernandes JG, et al. Stroke epidemiology, prevention, and management strategies at a regional level: Latin America and the Caribbean. Lancet Neurol 2007;6:362–72. https://doi.org/10.1016/S1474-4422(07)70003- 0.
5. Pepys MG and Hirschfield GM. C-reactive protein: a critical update. J Clin Invest2003;111(12).
6. Black S, Kushner I, Samols D. C-reactive protein. J BiolChem2004;279:48487-48490.
7. Chandrashekara S. C - reactive protein: An inflammatory marker with specific role in physiology, pathology, and diagnosis IJRCI. 2014;2(S1):SR3
8. Leonardi-Bee J, Bath PMW, Phillips SJ, Sandercock PAG; for the IST Collaborative Group. Blood Pressure and Clinical Outcomes in the International Stroke Trial. Stroke. 2002; 33: 1315–1320.
9. Robinson T, Waddington A, Ward-Close S, Taub N, Potter J. The predictive role of 24-hour compared to casual blood pressure levels on outcome following acute stroke. Cerebrovasc Dis. 1997; 7: 264–272.
10. Bath FJ, Bath PMW. What is the correct management of blood pressure in acute stroke? The Blood Pressure in Acute Stroke Collaboration. Cerebrovasc Dis. 1997; 7: 205–213.
11. Chen B, Cui Y, Lei M, Xu W, Yan Q, Zhang X, Qin M, Xu S. C-Reactive Protein Levels in relation to Incidence of Hypertension in Chinese Adults: Longitudinal Analyses from the China Health and Nutrition Survey. International journal of hypertension. 2021 Dec 10;2021.
12. Kanmani S, Kwon M, Shin MK, Kim MK. Association of C-reactive protein with risk of developing type 2 diabetes mellitus, and role of obesity and hypertension: a large population-based Korean cohort study. Scientific reports. 2019 Mar 14;9(1):1-8.
13. Cai Y, Zhang H, Li Q, Zhang P. Correlation Between Blood Glucose Variability and Early Therapeutic Effects After Intravenous Thrombolysis With Alteplase and Levels of Serum Inflammatory Factors in Patients With Acute Ischemic Stroke. Frontiers in Neurology. 2022 Feb 22;13:806013
14. Pfützner A, Schöndorf T, Hanefeld M, Forst T. High-sensitivity C-reactive protein predicts cardiovascular risk in diabetic and nondiabetic patients: effects of insulin-sensitizing treatment with pioglitazone. Journal of diabetes science and technology. 2010 May;4(3):706-16.
15. Ghule A, Kamble TK, Talwar D, Kumar S, Acharya S, Wanjari A, Gaidhane SA, Agrawal S. Association of Serum High Sensitivity C-Reactive Protein With Pre-diabetes in Rural Population: A Two-Year Cross-Sectional Study. Cureus. 2021 Oct 28;13(10).
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.