Usefulness of inflammatory and haemostatic markers to predict short-term risk for death in middle-aged ischaemic stroke patients.
OBJECTIVE
There is increasing evidence that inflammation and hypercoagulability play an important role in the pathophysiology of acute ischaemic stroke. We examined the in-hospital prognostic value on mortality of C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-alpha), fibrinogen and D-dimer in middle-aged ischaemic stroke patients.


METHODS
We recruited 231 consecutive patients <66 years with acute ischaemic stroke. CRP, TNF-alpha, fibrinogen and D-dimer levels were determined within 12 h from admission.


RESULTS
Fifteen (6.5%) patients died during hospitalization. CRP, fibrinogen and D-dimer levels were significantly higher in patients who died compared with those who survived but only CRP and fibrinogen were independently associated with death, after adjusting for various confounding factors. For 1 mg/l increase in CRP there was a 20% higher risk of dying while for 10 mg/dl increase in fibrinogen the additive risk was 18%. CRP levels >18 mg/l and fibrinogen levels >490 mg/dl were the optimal points that discriminated those who died from the rest.


CONCLUSIONS
CRP and fibrinogen levels can predict independently the risk of early death in middle-aged ischaemic stroke patients emphasizing the role of inflammation and coagulation in the evolution of ischaemic stroke.
Rallidis
L S
LS
Second Department of Cardiology, University General Hospital Attikon, Athens. rallidis@ath.forthnet.gr
Vikelis
M
M
Panagiotakos
D B
DB
Liakos
G K
GK
Krania
E
E
Kremastinos
D T
DT
D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000150:complications*; D002097:C-Reactive Protein / Q000032:analysis; D004660:Encephalitis / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D012306:Risk; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D019851:Thrombophilia / Q000150:complications / Q000175:diagnosis*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D014409:Tumor Necrosis Factor-alpha; C036309:fibrin fragment D; D005340:Fibrinogen; D002097:C-Reactive Protein