The Role of Hs-CRP, D-Dimer and Fibrinogen in Differentiating Etiological Subtypes of Ischemic Stroke

Abstract

The aim of this study was to evaluate the diagnostic value of the serum biochemical markers high-sensitivity C-reactive protein (hs-CRP), D-dimer (DD) and fibrinogen (Fg) in differentiating etiological subtypes of ischemic stroke. This study was a retrospective case-only study, consecutively including patients with acute ischemic stroke. All patients were classified into subtypes using the TOAST classification system. A total of 317 patients were evaluated. Hs-CRP and DD levels were significantly different among the subtypes and were the highest in CE, followed by LAA and SAA; no significant difference between the subtypes was found for Fg. Hs-CRP > 6.96 mg/L was classified as the CE subtype, with a sensitivity of 41% and a specificity of 74%; DD > 791.30 ng/mL was classified as CE, with a sensitivity of 58% and a specificity of 78%. The combination of hs-CRP and DD classification as CE yielded a sensitivity of 65% and a specificity of 91%. DD > 791.30 ng/mL was considered an independent predictive factor of CE. Hs-CRP and DD could be useful for identifying the etiological subtypes of acute ischemic stroke, especially for predicting CE. The diagnostic value of DD was higher than that of hs-CRP.

The Role of D-Dimer, Fibrinogen and C-Reactive Protein as Plasma Biomarkers in Acute Ischemic Stroke

“…There was a significant difference between cardioembolic and atherosclerotic groups and between cardioembolic and lacunar groups and between cardioembolic and undermined/other groups. This coincides with Liu [20] who found that D-dimer levels were significantly different among the subtypes and were the highest in cardioembolic followed by large artery atherosclerosis and small artery occlusion. In contrast to our results, Takano et al [21] found marked elevation of plasma concentration of D-dimer was observed only in cardioembolic versus control within 48 h of onset persisting for 1 month with a gradual decline.…”

Circulating miR‐145 is associated with plasma high‐sensitivity C‐reactive protein in acute ischemic stroke patients

“…The combination of hs‐CRP and D‐dimer improves the diagnosis accuracy of cardioembolism in the acute phase . Higher hs‐CRP level and lipoprotein‐related phospholipase A2 (Lp‐PLA2) activity are significantly associated with more severe neurologic impairment and larger infarct size in patients who have AIS . Hs‐CRP and homocysteine are independent predictors of short‐term outcome and mortality after AIS.…”

Update on Inflammatory Biomarkers and Treatments in Ischemic Stroke

“…Especially D-dimer was effective in identifying IS etiology [181,182] and showed good prognostic accuracy as predictor of short- and long-term worse outcome [182,183,185,186]. Similar results were also reported for E-selectin and VCAM-1, but those data required further validation in additional large-cohort studies [184].…”

“…Furthermore, specific challenges regarding biomarkers of central nervous tissue include the penetration of BBB and the lack of correlation between functional symptoms and volume (as opposed to location) of injured tissue. According to pathophysiological processes underlying IS, potential inflammatory biomarkers may be classified as released by: (i) astroglial activation and neuronal injury (Table 1) [146,147,148,149,150,151,152,153,154,155,156,157]; (ii) systemic inflammatory response (Table 2) [158,159,160,161,162,163,164,165,166,167,168,169,170,171,172,173,174,175,176,177,178,179]; (iii) dysfunctional endothelium (Table 3) [180,181,182,183,184,185,186] (Figure 4). …”