Association between C-reactive protein change and outcome after stroke_West China Medical Journal

Authors：

LIU Zhiqian ^1,2 , LIU Ruishan ³ ,  WANG Lu ^1,2 ,  ZHANG Shihong ³

1. Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan 610041, P. R. China;
3. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

WANG Lu, Email: wanglu0823@scu.edu.cn; ZHANG Shihong, Email: zsh9@hotmail.com

Keywords：

C-reactive protein change; inflammation; stroke; prognosis; death

DOI：

10.7507/1002-0179.202304064

Video：

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Objective To explore the association between C-reactive protein (CRP) change and the prognosis of patients with stroke. Methods Individuals who were diagnosed with stroke from the 2011 China Health and Retirement Longitudinal Study (CHARLS) registry were included. The baseline characteristics in 2011, blood tests in 2011 and 2015, and follow-up data in 2018 were collected. The patients were divided into three groups according to their CPR change from 2011 to 2015, and the cut-off values of CRP change were 0 and 5 mg/L. Logistic regression analysis was performed to evaluate the association between CRP change and the risk of death after stroke. Results A total of 1065 participants diagnosed in 2011 were enrolled. There were 383 participants in the CRP decreased group (CRP change ranging from –74.30 to –0.01 mg/L), 584 participants in the CRP stable group (CRP change ranging from 0 to 4.98 mg/L), and 98 participants in the CRP increased group (CRP change ranging from 5.00 to 79.27 mg/L). By 2018, the numbers (rates) of deaths in CRP decreased group, CRP stable group, and CRP increased group were 25 (6.53%), 33 (5.65%), and 13 (13.27%), respectively, and the difference in the mortality among the three groups was statistically significant (P=0.020). Logistic regression analysis showed that the CRP change≥5 mg/L was associated with a higher risk of death after stroke [odds ratio=2.332, 95% confidence interval (1.099, 4.946), P=0.027]. Conclusions Increasing CRP levels over time may indicate an increased risk of death in stroke patients. A 4-year increase in CRP greater than 5 mg/L may be an independent predictor of the risk of long-term death in stroke patients.

Citation： LIU Zhiqian, LIU Ruishan, WANG Lu, ZHANG Shihong. Association between C-reactive protein change and outcome after stroke. West China Medical Journal, 2023, 38(5): 663-667. doi: 10.7507/1002-0179.202304064 Copy

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2.	Feigin VL, Nguyen G, et al. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. N Engl J Med, 2018, 379(25): 2429-2437.
3.	王亞楠, 吳思緲, 劉鳴. 中國腦卒中 15 年變化趨勢和特點. 華西醫學, 2021, 36(6): 803-807.
4.	郭文, 吳思緲, 劉鳴. 提倡強化危重癥腦梗死分類分期預防意識. 華西醫學, 2021, 36(6): 701-706.
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7.	Verma S, Yeh ET. C-reactive protein and atherothrombosis-beyond a biomarker: an actual partaker of lesion formation. Am J Physiol Regul Integr Comp Physiol, 2003, 285(5): R1253-1256.
8.	Pedersen ED, Waje-Andreassen U, Vedeler CA, et al. Systemic complement activation following human acute ischaemic stroke. Clin Exp Immunol, 2004, 137(1): 117-122.
9.	VanGilder RL, Davidov DM, Stinehart KR, et al. C-reactive protein and long-term ischemic stroke prognosis. J Clin Neurosci, 2014, 21(4): 547-553.
10.	Di Napoli M, Schwaninger M, Cappelli R, et al. Evaluation of C-reactive protein measurement for assessing the risk and prognosis in ischemic stroke: a statement for health care professionals from the CRP Pooling Project members. Stroke, 2005, 36(6): 1316-1329.
11.	Matsuo R, Ago T, Hata J, et al. Plasma C-reactive protein and clinical outcomes after acute ischemic stroke: a prospective observational study. PLoS One, 2016, 11(6): e0156790.
12.	Karlinski M, Bembenek J, Grabska K, et al. Routine serum C-reactive protein and stroke outcome after intravenous thrombolysis. Acta Neurol Scand, 2014, 130(5): 305-311.
13.	Topakian R, Strasak AM, Nussbaumer K, et al. Prognostic value of admission C-reactive protein in stroke patients undergoing IV thrombolysis. J Neurol, 2008, 255(8): 1190-1196.
14.	Zhao Y, Hu Y, Smith J P, et al. Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS). Int J Epidemiol, 2014, 43(1): 61-68.
15.	Berkley A, Ferro A. Changes in C-reactive protein in response to anti-inflammatory therapy as a predictor of cardiovascular outcomes: a systematic review and meta-analysis. JRSM Cardiovasc Dis, 2020, 9: 2048004020929235.
16.	Wang L, Li Y, Wang C, et al. C-reactive protein, infection, and outcome after acute ischemic stroke: a registry and systematic review. Curr Neurovasc Res, 2019, 16(5): 405-415.
17.	Borowicz W, Ptaszkowski K, Ptaszkowska L, et al. Assessment of changes in serum C-reactive protein levels in patients after ischemic stroke undergoing rehabilitation-a retrospective observational study. J Clin Med, 2023, 12(3): 1029.
18.	Shoaeb MA, Shehata MA, Taema KM, et al. CRP in cerebrovascular stroke: prognostic implications. Egypt J Crit Care Med, 2014, 2(1): 43-52.
19.	Wnuk M, Derbisz J, Drabik L, et al. C-reactive protein and white blood cell count in non-infective acute ischemic stroke patients treated with intravenous thrombolysis. J Clin Med, 2021, 10(8): 1610.
20.	Montaner J, Fernandez-Cadenas I, Molina CA, et al. Poststroke C-reactive protein is a powerful prognostic tool among candidates for thrombolysis. Stroke, 2006, 37(5): 1205-1210.

1. Campbell BCV, Khatri P. Stroke. Lancet, 2020, 396(10244): 129-142.
2. Feigin VL, Nguyen G, et al. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. N Engl J Med, 2018, 379(25): 2429-2437.
3. 王亞楠, 吳思緲, 劉鳴. 中國腦卒中 15 年變化趨勢和特點. 華西醫學, 2021, 36(6): 803-807.
4. 郭文, 吳思緲, 劉鳴. 提倡強化危重癥腦梗死分類分期預防意識. 華西醫學, 2021, 36(6): 701-706.
5. Paciaroni M, Bogousslavsky J. Primary and secondary prevention of ischemic stroke. Eur Neurol, 2010, 63(5): 267-278.
6. Smith CJ, Emsley HC, Vail A, et al. Variability of the systemic acute phase response after ischemic stroke. J Neurol Sci, 2006, 251(1/2): 77-81.
7. Verma S, Yeh ET. C-reactive protein and atherothrombosis-beyond a biomarker: an actual partaker of lesion formation. Am J Physiol Regul Integr Comp Physiol, 2003, 285(5): R1253-1256.
8. Pedersen ED, Waje-Andreassen U, Vedeler CA, et al. Systemic complement activation following human acute ischaemic stroke. Clin Exp Immunol, 2004, 137(1): 117-122.
9. VanGilder RL, Davidov DM, Stinehart KR, et al. C-reactive protein and long-term ischemic stroke prognosis. J Clin Neurosci, 2014, 21(4): 547-553.
10. Di Napoli M, Schwaninger M, Cappelli R, et al. Evaluation of C-reactive protein measurement for assessing the risk and prognosis in ischemic stroke: a statement for health care professionals from the CRP Pooling Project members. Stroke, 2005, 36(6): 1316-1329.
11. Matsuo R, Ago T, Hata J, et al. Plasma C-reactive protein and clinical outcomes after acute ischemic stroke: a prospective observational study. PLoS One, 2016, 11(6): e0156790.
12. Karlinski M, Bembenek J, Grabska K, et al. Routine serum C-reactive protein and stroke outcome after intravenous thrombolysis. Acta Neurol Scand, 2014, 130(5): 305-311.
13. Topakian R, Strasak AM, Nussbaumer K, et al. Prognostic value of admission C-reactive protein in stroke patients undergoing IV thrombolysis. J Neurol, 2008, 255(8): 1190-1196.
14. Zhao Y, Hu Y, Smith J P, et al. Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS). Int J Epidemiol, 2014, 43(1): 61-68.
15. Berkley A, Ferro A. Changes in C-reactive protein in response to anti-inflammatory therapy as a predictor of cardiovascular outcomes: a systematic review and meta-analysis. JRSM Cardiovasc Dis, 2020, 9: 2048004020929235.
16. Wang L, Li Y, Wang C, et al. C-reactive protein, infection, and outcome after acute ischemic stroke: a registry and systematic review. Curr Neurovasc Res, 2019, 16(5): 405-415.
17. Borowicz W, Ptaszkowski K, Ptaszkowska L, et al. Assessment of changes in serum C-reactive protein levels in patients after ischemic stroke undergoing rehabilitation-a retrospective observational study. J Clin Med, 2023, 12(3): 1029.
18. Shoaeb MA, Shehata MA, Taema KM, et al. CRP in cerebrovascular stroke: prognostic implications. Egypt J Crit Care Med, 2014, 2(1): 43-52.
19. Wnuk M, Derbisz J, Drabik L, et al. C-reactive protein and white blood cell count in non-infective acute ischemic stroke patients treated with intravenous thrombolysis. J Clin Med, 2021, 10(8): 1610.
20. Montaner J, Fernandez-Cadenas I, Molina CA, et al. Poststroke C-reactive protein is a powerful prognostic tool among candidates for thrombolysis. Stroke, 2006, 37(5): 1205-1210.

West China Medical Journal

Association between C-reactive protein change and outcome after stroke

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