Comparison of acute versus convalescent stage high-sensitivity C-Reactive protein level in predicting clinical outcome after acute ischemic stroke and impact of erythropoietin.
OBJECTIVE
Currently, no data on the optimal time point after acute ischemic stroke (IS) at which high-sensitivity C-reactive protein (hs-CRP) level is most predictive of unfavorable outcome. We tested the hypothesis that hs-CRP levels during both acute (48 h after IS) and convalescent (21 days after IS) phases are equally important in predicting 90-day clinical outcome after acute IS. We further evaluated the impact of erythropoietin (EPO), an anti-inflammatory agent, on level of hs-CRP after acute IS.


METHODS
Totally 160 patients were prospectively randomized to receive either EPO therapy (group 1, n = 80) (5,000 IU each time, subcutaneously) at 48 h and 72 h after acute IS, or placebo (group 2, n = 80). Serum level of hs-CRP was determined using ELISA at 48 h and on day 21 after IS and once in 60 healthy volunteers.


RESULTS
Serum level of hs-CRP was substantially higher in all patients with IS than in healthy controls at 48 h and day 21 after IS (all p < 0.001). Levels of hs-CRP did not differ between group 1 and 2 at 48 h and day 21 after IS (all p > 0.5). Multivariate analysis showed that hs-CRP levels (at 48 h and day 21) were independently predictive of 90-day major adverse neurological event (MANE) (defined as recurrent stroke, NIHSS≥8, or death) (all p < 0.03), whereas EPO therapy was independently predictive of reduced 90-day MANE (all p < 0.02).


CONCLUSIONS
EPO therapy which was independently predictive of freedom from 90-day MANE did not alter the crucial role of hs-CRP levels measured at 48 h and 21-day in predicting unfavorable clinical outcome after IS.
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Kuo-Ho
KH
Yeh
Tzu-Hsien
TH
Tsai
Han-Tan
HT
Chai
Steve
S
Leu
Sheng-Ying
SY
Chung
Sarah
S
Chua
Yung-Lung
YL
Chen
Hung-Sheng
HS
Lin
Chun-Man
CM
Yuen
Hon-Kan
HK
Yip
D000368:Aged; D002545:Brain Ischemia / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D003289:Convalescence; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D018709:Statistics, Nonparametric; D020521:Stroke / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D016896:Treatment Outcome
D004921:Erythropoietin; D002097:C-Reactive Protein