C-Reactive Protein Levels and Cognitive Decline following Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Abstract

Cognitive decline (CD) is devastating with a high incidence in patients after stroke. Although some studies have explored underlying associations between C-reactive protein (CRP) levels and cognitive decline after stroke, consistent results have not been obtained. Therefore, this meta-analysis aimed to explore whether or not higher levels of C-reactive proteins were associated with an increased risk of cognitive decline after stroke. To this end, PubMed, Embase, the Cochrane Library, and Web of Science were searched for eligible studies, and pooled effect sizes from eligible studies were calculated using random effect models. Furthermore, subgroups were established and meta-regression analyses were performed to explain the causes of heterogeneity. Eventually, nine studies with 3893 participants were included. Our statistical results suggested that the concentrations of peripheral CRP may be significantly increased for CD patients after stroke, compared to those of non-CD patients. Subgroup analyses showed that CRP was higher in CD than that in non-CD patients when the mini-mental state examination was used. A higher level of CRP in the acute phase of ischemic stroke may suggest an increased risk of CD after stroke. However, these results should be cautiously interpreted because of the limited sample sizes and the diversity of potential confounders in the studies included in this meta-analysis.

Risk factors and predictive markers of post-stroke cognitive decline–A mini review

“…An increased number of studies have investigated the expression of biomarkers such as C-reactive protein (CRP), interleukin 6 (IL-6), and interleukin 10 (IL-10). In 2023, a Meta-Analysis that involved nine studies with 3,893 participants showed the concentrations of peripheral CRP, especially in the acute stroke phase, are significantly increased for patients with cognitive decline after stroke compared to the patients without cognitive decline ( Wang et al, 2023 ). A prospective study conducted in 2022 that involved 1,003 stroke patients indicated elevated IL-6 levels were independently linked to a decline in MoCA scores following ischemic stroke and transient ischemic attack (TIA) ( Wang et al, 2022 ).…”

Role of the gut microbiota in complications after ischemic stroke

“…The secretion of IL-17 by T cells leads to the production of chemokines from peripheral medullary cells (monocytes and neutrophils), thereby damaging the blood-brain barrier and inducing neuroinflammation, which exacerbates ischemic brain injury (Samuelson et al, 2019;Wang et al, 2022). In addition, intestinal microorganisms enter the circulation and extraintestinal organs, leading to local and systemic infections (Wang et al, 2023b).…”

“…infection (PSI), which impact disease prognosis, resulting in progressive neurological deficits and high mortality (Lindner et al, 2019;Ułamek-Kozioł et al, 2020;Huang et al, 2022;Zhang et al, 2022;Hede Ebbesen et al, 2023;Wang et al, 2023b).…”