C-reactive protein and outcome after ischemic stroke.
OBJECTIVE
Elevated concentrations of the acute-phase reactant C-reactive protein (CRP) predict ischemic cardiac events in both hospital- and population-based studies and may signify a role for inflammation in the destabilization of cardiovascular disease. We examined the relationship between CRP and outcome after acute ischemic stroke.


METHODS
This was a subgroup analysis from a prospective observational study based in a University Hospital Acute Stroke Unit serving a population of approximately 260 000. Survival time and cause of death for up to 4 years after the index stroke were determined and related to CRP concentration within 72 hours of stroke and known prognostic variables by a Cox proportional hazards regression model.


RESULTS
Ischemic stroke was diagnosed in 228 of 283 consecutive admissions. Median follow-up was 959 days. Geometric mean CRP concentration was 10.1 mg/L. Survival in those with CRP >10.1 mg/L was significantly worse than in those with CRP </=10.1 mg/L (P=0.00009, log-rank test). Higher CRP concentration was an independent predictor of mortality (hazard ratio, 1.23 per additional natural log unit; 95% CI, 1.13 to 1.35; P=0.02), together with age and stroke severity on the National Institutes of Health Stroke Scale. Cardiovascular disease accounted for 76% of deaths in those with CRP >10.1 mg/L and 63% of deaths in those with CRP </=10. 1 mg/L.


CONCLUSIONS
CRP concentration is an independent predictor of survival after ischemic stroke. These findings are consistent with a role for inflammation in acute ischemic stroke, as well as with the hypothesis that elevated CRP may predict future cardiovascular mortality.
Muir
K W
KW
Acute Stroke Unit, University Department of Medicine, Department of Immunology, Glasgow, Scotland. k.muir@clinmed.gla.ac.uk
Weir
C J
CJ
Alwan
W
W
Squire
I B
IB
Lees
K R
KR
D000210:Acute-Phase Reaction / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000276:immunology / Q000378:metabolism* / Q000401:mortality; D002097:C-Reactive Protein / Q000032:analysis*; D002561:Cerebrovascular Disorders / Q000276:immunology / Q000378:metabolism* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome
D002097:C-Reactive Protein