C-reactive protein in the very early phase of acute ischemic stroke: association with poor outcome and death

Abstract:: Acute Ischemic Stroke (AIS) is currently the most frequently reported neurological complication of Coronavirus disease 2019 (COVID-19). This article will elaborate on the clinical features of inpatients with COVID-19 and AIS and the pathophysiological mechanism of AIS under the background of COVID-19. Through a detailed search of relevant studies, we found that the incidence of AIS among COVID-19 patients varied from 0.9% to 4.6%, and AIS has been observed in many people without underlying diseases and cardiovascular risk factors as well as young people. The National Institute of Health Stroke Scale (NIHSS) score of COVID-19 patients with AIS was higher than historical AIS patients, and the proportion of large vessel occlusion (LVO) was about 64.2%. COVID-19 patients with AIS have commonly high levels of D-D dimer, fibrinogen, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), suggesting systemic hyperinflammatory and hypercoagulable state. The pooled mortality of COVID-19 patients with AIS was 38% and the mortality of LVO patients is higher (45.9%). Compared with COVID-19-negative AIS patients in the same period in 2020 and 2019, COVID- 19 patients with AIS had a worse prognosis.

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C-Reactive Protein and White Blood Cell Count in Non-Infective Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Journal of Clinical Medicine ◽

10.3390/jcm10081610 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1610

Author(s):

Marcin Wnuk ◽

Justyna Derbisz ◽

Leszek Drabik ◽

Agnieszka Slowik

Keyword(s):

Ischemic Stroke ◽

Blood Cell ◽

Acute Ischemic Stroke ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

Intravenous Thrombolysis ◽

C Reactive Protein ◽

Blood Cell Count ◽

Reactive Protein

Background: Previous studies on inflammatory biomarkers in acute ischemic stroke (AIS) produced divergent results. We evaluated whether C-reactive protein (CRP) and white blood cell count (WBC) measured fasting 12–24 h after intravenous thrombolysis (IVT) were associated with outcome in AIS patients without concomitant infection. Methods: The study included 352 AIS patients treated with IVT. Excluded were patients with community-acquired or nosocomial infection. Outcome was measured on discharge and 90 days after stroke onset with the modified Rankin scale (mRS) and defined as poor outcome (mRS 3–6) or death (mRS = 6). Results: Final analysis included 158 patients (median age 72 years (interquartile range 63-82), 53.2% (n = 84) women). Poor outcome on discharge and at day 90 was 3.8-fold and 5.8-fold higher for patients with CRP ≥ 8.65 mg/L (fifth quintile of CRP), respectively, compared with first quintile (<1.71 mg/L). These results remained significant after adjustment for potential confounders (odds ratio (OR) on discharge = 10.68, 95% CI: 2.54–44.83, OR at day 90 after stroke = 7.21, 95% CI: 1.44–36.00). In-hospital death was 6.3-fold higher for patients with fifth quintile of CRP as compared with first quintile and remained independent from other variables (OR = 4.79, 95% CI: 1.29–17.88). Independent predictors of 90-day mortality were WBC < 6.4 × 109 /L (OR = 5.00, 95% CI: 1.49–16.78), baseline National Institute of Health Stroke Scale (NIHSS) score (OR = 1.13 per point, 95% CI: 1.01–1.25) and bleeding brain complications (OR = 5.53, 95% CI: 1.59–19.25) but not CRP ≥ 8.65 mg/L. Conclusions: Non-infective CRP levels are an independent risk factor for poor short- and long-term outcomes and in-hospital mortality in AIS patients treated with IVT. Decreased WBC but not CRP is a predictor for 90-day mortality.

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Effect of vitamin D levels on lipid, glucose, vitamin B12 and C-reactive protein in acute ischemic stroke"

Annals of Medical Research ◽

10.5455/annalsmedres.2020.04.399 ◽

2021 ◽

Vol 28 (5) ◽

pp. 879

Author(s):

Nalan Kozaci ◽

Cafer Caliskan ◽

Mustafa Avci ◽

Gulsum Caliskan ◽

Ilhan Uysal

Keyword(s):

Vitamin D ◽

Ischemic Stroke ◽

Vitamin B12 ◽

Acute Ischemic Stroke ◽

C Reactive Protein ◽

Reactive Protein ◽

Vitamin D Levels

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PLASMA C - REACTIVE PROTEIN LEVELS AS A PROGNOSTIC MARKER IN FIRST EVER ACUTE ISCHEMIC STROKE

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2014/4004 ◽

2014 ◽

Vol 3 (70) ◽

pp. 14905-14913

Author(s):

Bharat Konin ◽

Savita Konin ◽

Sudhanva V Kinhal ◽

Niraj Saraf

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Prognostic Marker ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein

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Abstract 2874: Functional Polymorphisms in Toll-like Receptor 4 Predict Worse Outcome in Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.43.suppl_1.a2874 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Jonathan R Weinstein ◽

Juliane Schulze ◽

Richard V Lee ◽

Dannielle Zierath ◽

Patricia Tanzi ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Immune Cell ◽

Stroke Severity ◽

Multiple Time ◽

Toll Like Receptor ◽

C Reactive Protein ◽

Toll Like Receptor 4 ◽

Reactive Protein ◽

Functional Polymorphisms

Background: Toll-like receptor-4 (TLR4) plays a central role in the pathophysiology of acute ischemic stroke (AIS). Specific single nucleotide polymorphisms (SNPs) in TLR4 including 1063 A/G [Asp299Gly] and 1363 C/T [Thr399Ile] alter immune cell responsiveness to lipopolysaccharide (LPS) and are associated with increased rates of infection. The effect of these TLR4 SNPs on outcome following AIS is unknown. Methods: Patients were prospectively enrolled after onset of AIS. Clinical and demographic data were collected and neurological outcomes assessed at 3 months. Blood was drawn at multiple time points to quantify leukocyte subsets and assess plasma levels of C-reactive protein and a panel of cytokines. Genotyping for the TLR4 SNPs was also performed on blood samples. Uni- and multivariate analyses were performed to assess associations between TLR4 SNP haplotype and (i) each laboratory parameter noted above, (ii) infection risk and (iii) stroke outcome. Results: Of the 42 patients included; 6 (14%) were heterozygous for either one or both TLR4 SNPs. Baseline characteristics were similar in patients with or without a TLR4 SNP. In analyses adjusted for both initial stroke severity and age, the presence of a TLR4 SNP was associated with increases in blood leukocytes, plasma C-reactive protein and the cytokine interleukin-1 receptor antagonist (IL-1ra). The presence of either TLR4 SNP was also associated with a trend toward increased rates of infection (adjusted odds ratio and 95% confidence interval of 8.20 and 0.826-81.5, respectively) and a decreased likelihood of favorable outcome as defined by a modified Rankin Scale score of two or less at three months from stroke onset (0.014, 0.00-0.759). Conclusions: In AIS patients, functionally significant genetic variations in TLR4 influence both rates of stroke-associated infection and neurological outcome. These data suggest a direct connection between TLR4 function and stroke pathophysiology.

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Erratum to: Serum levels of cytokines and C-reactive protein in acute ischemic stroke patients, and their relationship to stroke lateralization, type, and infarct volume

Journal of Neurology ◽

10.1007/s00415-011-6333-1 ◽

2011 ◽

Vol 259 (2) ◽

pp. 400-400 ◽

Cited By ~ 1

Author(s):

Heidi Ormstad ◽

Hans Christian Dalsbotten Aass ◽

Niels Lund-Sørensen ◽

Karl-Friedrich Amthor ◽

Leif Sandvik

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Infarct Volume ◽

Serum Levels ◽

C Reactive Protein ◽

Stroke Patients ◽

Reactive Protein

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C-reactive protein for predicting all-cause mortality in patients with acute ischemic stroke: a meta-analysis

Bioscience Reports ◽

10.1042/bsr20181135 ◽

2019 ◽

Vol 39 (2) ◽

Cited By ~ 6

Author(s):

Bo Yu ◽

Ping Yang ◽

Xuebi Xu ◽

Lufei Shao

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Observational Studies ◽

Meta Analysis ◽

C Reactive Protein ◽

Stroke Patients ◽

Reactive Protein ◽

Increased Risk ◽

All Cause Mortality ◽

Unit Increase

Abstract Studies on the association of C-reactive protein (CRP) with all-cause mortality in acute ischemic stroke patients have yielded conflicting results. The objective of this meta-analysis was to evaluate the prognostic value of CRP elevation in predicting all-cause mortality amongst patients with acute ischemic stroke. We searched the original observational studies that evaluated the association of CRP elevation with all-cause mortality in patients with acute ischemic stroke using PubMed and Embase databases until 20 January 2018. Pooled multivariate-adjusted hazard ratio (HR) with 95% confidence intervals (CI) of all-cause mortality was obtained for the highest compared with the lowest CRP level or per unit increment CRP level. A total of 3604 patients with acute ischemic stroke from eight studies were identified. Acute ischemic stroke patients with the highest CRP level were independently associated with an increased risk of all-cause mortality (HR: 2.07; 95% CI: 1.60–2.68) compared with the lowest CRP category. The pooled HR of all-cause mortality was 2.40 (95% CI: 1.10–5.21) for per unit increase in log-transformed CRP. Elevated circulating CRP level is associated with the increased risk of all-cause mortality in acute ischemic stroke patients. This meta-analysis supports the routine use of CRP for the death risk stratification in such patients.

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