title: Homocysteine and C-reactive protein associated with progression and prognosis of intracranial branch atheromatous disease.
abstract: OBJECTIVE
  C-reactive protein (CRP) is a biomarker of inflammation and a sensitive predictor of stroke, and high homocysteine (Hcy) is also associated with stroke. However, the roles of CRP and Hcy in the pathogenesis, progression and prognosis of branch atheromatous disease (BAD) and lipohyalinotic degeneration (LD) are largely unknown. We sought to determine the relation between them in Chinese patients.
  
  
  METHODS
  According to the lesion presences shown by diffusion-weighted imaging (DWI), we retrospectively recruited a cohort of 308 patients with a diagnosis of BAD and LD from a total of 1458 consecutive patients with acute ischemic stroke. Progression was defined as worsening by > or  = 1-point in the NIHSS for motor function within the first 5 days. Good outcome was deemed as Modified Rankin Scale (mRS) ≤ 2 and poor outcome was mRS > 2 recorded at one month after onset.
  
  
  RESULTS
  This study comprised a total of 179 patients with BAD and 129 patients with LD. Subjects in patients with LD significantly had an elevated Hcy (p = 0.030), a lower NIHSS score on admission (p<0.001) and mRS score at one month after ictus (p<0.001) than those in patients with BAD. Elevated Hcy (P = 0.004) and increased CRP (P = 0.025) were associated with progression in patients with BAD, and CRP (p = 0.006) and diabetes mellitus (p = 0.011) were found to be associated with poor outcome in patients with BAD. However, no association was observed in patients with LD on progression and prognosis. After multivariate logistic regression analysis, elevated Hcy (p = 0.002) remained the only independent predictor for the progression, and increased CRP (p = 0.027) and smoking (p = 0.012) became the independent predictors for the poor outcome in patients with BAD.
  
  
  CONCLUSIONS
  In patients with BAD, elevated Hcy and increased CRP may independently predict progression and prognosis, respectively.
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China.
authors.forename: Xuejiao
authors.initials: X
authors.lastname: Men
authors.forename: Jiejie
authors.initials: J
authors.lastname: Li
authors.forename: Bingjun
authors.initials: B
authors.lastname: Zhang
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.forename: Haiyan
authors.initials: H
authors.lastname: Li
authors.forename: Zhengqi
authors.initials: Z
authors.lastname: Lu
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D018450:Disease Progression; D005260:Female; D006710:Homocysteine / Q000378:metabolism*; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D058226:Plaque, Atherosclerotic / Q000378:metabolism*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006710:Homocysteine; D002097:C-Reactive Protein
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