Evaluation of C-Reactive Protein Measurement for Assessing the Risk and Prognosis in Ischemic Stroke

Abstract

Background and Purpose-Several studies have shown, in different populations, that modest elevation of plasma C-reactive protein (CRP) in the range seen in apparently healthy individuals is a strong predictor of future vascular events. Elevated plasma CRP concentrations are also associated with an increased risk of cerebrovascular events and an increased risk of fatal and nonfatal cardiovascular events in ischemic stroke patients. These epidemiological and clinical observations suggest that determination of plasma CRP concentrations could be used as an adjunct for risk assessment in primary and secondary prevention of cerebrovascular disease and be of prognostic value. The aim of this review is to summarize the evidence for CRP as an independent predictor of cerebrovascular events in at-risk individuals and ischemic stroke patients and to consider its usefulness in evaluating prognosis after stroke. Summary of Review-CRP fulfils most of the requirements of a new risk and prognostic predictor, but several issues await further confirmation and clarification before this marker can be included in the routine evaluation of stroke patients and subjects at risk for cerebrovascular disease. Potentially important associations have been established between elevated plasma CRP concentrations and increased efficacy of established therapies, particularly lipid-lowering therapy with statins. Conclusion-At present, there is not sufficient evidence to recommend measurement of CRP in the routine evaluation of cerebrovascular disease risk in primary prevention, because there is insufficient evidence as to whether early detection, or intervention based on detection, improves health outcomes, although shared risk of cardiovascular disease indicates this may be of value. In secondary prevention of stroke, elevated CRP adds to existing prognostic markers, but it remains to be established whether specific therapeutic options can be derived from this.

Lipoprotein-Associated Phospholipase A 2 and C-Reactive Protein for Risk-Stratification of Patients With TIA

“…The role of CRP in predicting recurrent events in patients with cerebrovascular disease is controversial. 18 In a cohort of 467 patients with ischemic stroke from the Northern Manhattan Stroke Study, CRP was not associated with recurrent stroke or the composite of stroke, MI, and vascular death, but was associated with mortality. 11 In several smaller cohorts of patients with acute ischemic stroke, CRP has been predictive of recurrent vascular events or death, but with variable results depending on the timing of CRP measurement.…”

Blood Biomarkers of Ischemic Stroke

“…Myelination of CNS>PNS Diagnosis [104] Infarct volume [103] Stroke severity [103] Inflammatory Biomarkers CRP Liver synthesis Acute phase reactant, role in atherotherombosis & ischemic injury [105] Diagnosis [106] Stroke risk [62,[107][108][109] IL-6 Cytokine from T-cells+ macrophages Acute phase response, fever Infarct volume [53][54][55]110] Stroke Severity [110] END [53,54] TNF-α Cytokine, inflammatory cells Inflammation, Acute phase response Infarct volume [53] Stroke Severity [53] END [72] VCAM 1 Immunoglobulin Leukocyte-endothelial cell interaction Diagnosis [19] Infarct volume [53] ICAM 1 Immunoglobulin Leukocyte-endothelial cell interaction…”

Relationship between Baseline White Blood Cell and C-Reactive Protein with Mortality in Patients with Spontaneous Intracerebral Hemorrhage

“…Several prospective studies have been indicated that brain injury secondary to a sICH is characterized by acute local inflammation deterioration in sICH [11,12]. Another of the most promising of these inflammatory markers is C-reactive protein (CRP), a biomarker of inflammation that has been shown to predict prognosis in ischemic stroke after adjustment for all major prognostic components [15]. Unfortunately, previous studies have only marginally evaluated CRP as a prognostic marker after sICH with contrasting results [14,16] .This has led to a renewed interest in the study of inflammation markers, including CRP and WBC count, in sICH.…”