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

Abstract

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.

Prognostic significance of age in patients with acute ischaemic stroke treated with intravenous thrombolysis

“…As shown in our previous study, CRP levels evaluated in a different time window, i.e. 12-24 hours after IVT, were an independent risk factor for poor short-term and long-term outcomes and were also associated with in-hospital mortality [20]. Analysis of healthy individuals showed that people aged 65 or more had significantly higher CRP levels than their younger counterparts [21].…”

Elevated Albumin to Globulin Ratio on Day 7 is Associated with Improved Function Outcomes in Acute Ischemic Stroke Patients with Intravenous Thrombolysis

“… 13 Non-infective C-reactive protein level is an independent risk factor for poor prognosis in AIS patients with IVT treatment. 14 Besides, previous literatures also suggested that increased plasma fibrinogen was associated with reduced chance of favorable outcome in ischemic stroke patients. 15 , 16 Consistent with the previous data, our study demonstrated that AIS patients with poor outcome tended to have lower globulin levels.…”

Systemic Inflammation Response Index Predicts Clinical Outcomes in Patients With Acute Ischemic Stroke (AIS) After the Treatment of Intravenous Thrombolysis

“…However, the evaluation of a single-cellular type is insufficient for an estimation of the status of the immune response. Moreover, certain external disruptive factors may affect the blood routine examination, 40 and therefore, a variety of ratios or indices that incorporate multiple cell detection values are generally applied in clinical practice 14–16 . These measurements have been demonstrated to be more reliable than assessments based on a single-cellular type 41 .…”

“…Previous studies have identified the association between the clinical outcome and inflammatory biomarkers in the serum of patients with AIS; 10–13 however, the association between inflammatory biomarkers in the serum and functional recovery in AIS patients who undergo IVT is limited. To the best of our knowledge, various inflammatory indexes, including the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), high-sensitivity C-reactive protein, and platelet-to-lymphocyte ratio (PLR), are involved in the outcome of patients with AIS 14–16 . Nevertheless, the mechanisms potentially associated with inflammatory responses in the pathology of AIS have yet to be fully elucidated; moreover, the relationship between the outcomes of AIS and the inflammatory factors merits further determination.…”