Prognostic Relevance of C-Reactive Protein in Short Term Adverse Outcome in Patients with Acute Ischaemic Stroke

Abstract

Introduction: Elevated C-Reactive Protein (CRP) is a predictive marker for future cardiovascular events in ischaemic stroke patients but the timing of CRP evaluation in relation to the onset of the qualifying event has not been determined. Aim: To study the predictive accuracy of CRP in relation to adverse outcome of patients with acute ischaemic stroke. Materials and Methods: This prospective single centre, observational study was conducted on 62 cases of acute ischaemic stroke admitted to the Department of Medicine, SCB Medical College and Hospital, Cuttack, Odisha, India. CRP was determined quantitatively in all the patients of ischaemic stroke both at the time of admission and discharge. The CRP value was correlated with infarct size (Computed Tomography (CT) scan), mortality, morbidity (disability i.e., Barthel Index (BI), Canadian Neurologic Stroke Scale (CNSS) and vascular events). The end points were death or any new non fatal vascular events (recurrent stroke, unstable angina, myocardial infarction) recorded during six months of follow-up period. Results: CRP at admission correlates with the occurrence of fatal events only but CRP at discharge correlates with occurrence of both fatal and non fatal events. On follow-up occurrence of events correlates more strongly with CRP at admission. Out of total 14 non fatal events, maximum was restroke i.e., 7 (50%) which occurs in high CRP group. BI (degree of disability), both on admission and at six months strongly correlated with CRP at discharge (p-value=0.008 and 0.001 respectively). Conclusion: The severity of stroke and degree of disability was highest in high CRP group. The CRP at discharge was a better predictor of future outcome in terms of fatal and non fatal events than CRP at admission.