title: C-reactive protein and long-term ischemic stroke prognosis.
abstract: C-reactive protein (CRP) is an inflammatory biomarker of inflammation and may reflect progression of vascular disease. Conflicting evidence suggests CRP may be a prognostic biomarker of ischemic stroke outcome. Most studies that have examined the relationship between CRP and ischemic stroke outcome have used mortality or subsequent vascular event as the primary outcome measure. Given that nearly half of stroke patients experience moderate to severe functional impairments, using a biomarker like CRP to predict functional recovery rather than mortality may have clinical utility for guiding acute stroke treatments. The primary aim of this study was to systematically and critically review the relationship between CRP and long-term functional outcome in ischemic stroke patients to evaluate the current state of the literature. PubMed and MEDLINE databases were searched for original studies which assessed the relationship between acute CRP levels measured within 24 hours of symptom onset and long-term functional outcome. The search yielded articles published between 1989 and 2012. Included studies used neuroimaging to confirm ischemic stroke diagnosis, high-sensitivity CRP assay, and a functional outcome scale to assess prognosis beyond 30 days after stroke. Study quality was assessed using the REMARK recommendations. Five studies met all inclusion criteria. Results indicate a significant association between elevated baseline high sensitivity CRP and unfavorable long-term functional outcome. Our results emphasize the need for additional research to characterize the relationship between acute inflammatory markers and long-term functional outcome using well-defined diagnostic criteria. Additional studies are warranted to prospectively examine the relationship between high sensitivity CRP measures and long-term outcome.
authors.affiliation: Morgantown Department, West Virginia University School of Nursing, Morgantown, WV, USA; Department of Emergency Medicine, West Virginia University School of Medicine, P.O. Box 9303, Morgantown, WV 26506, USA.
authors.forename: Reyna L
authors.initials: RL
authors.lastname: VanGilder
authors.affiliation: Department of Emergency Medicine, West Virginia University School of Medicine, P.O. Box 9303, Morgantown, WV 26506, USA.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Davidov
authors.affiliation: West Virginia University School of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Stinehart
authors.affiliation: West Virginia University School of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Huber
authors.affiliation: Department of Human Performance -Division of Exercise Physiology, School of Medicine, West Virginia University, USA; Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Turner
authors.affiliation: Department of Basic Pharmaceutical Sciences, West Virginia University School of Pharmacy, Morgantown, WV, USA.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Wilson
authors.affiliation: Department of Basic Pharmaceutical Sciences, West Virginia University School of Pharmacy, Morgantown, WV, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Haney
authors.affiliation: Department of Emergency Medicine, West Virginia University School of Medicine, P.O. Box 9303, Morgantown, WV 26506, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Davis
authors.affiliation: Department of Basic Pharmaceutical Sciences, West Virginia University School of Pharmacy, Morgantown, WV, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Chantler
authors.affiliation: Morgantown Department, West Virginia University School of Nursing, Morgantown, WV, USA.
authors.forename: Laurie
authors.initials: L
authors.lastname: Theeke
authors.affiliation: Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Rosen
authors.affiliation: Department of Emergency Medicine, West Virginia University School of Medicine, P.O. Box 9303, Morgantown, WV 26506, USA.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Crocco
authors.affiliation: Department of Neurology, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Laurie
authors.initials: L
authors.lastname: Gutmann
authors.affiliation: Morgantown Department, West Virginia University School of Nursing, Morgantown, WV, USA; Department of Emergency Medicine, West Virginia University School of Medicine, P.O. Box 9303, Morgantown, WV 26506, USA. Electronic address: tlbarr@hsc.wvu.edu.
authors.forename: Taura L
authors.initials: TL
authors.lastname: Barr
mesh_terms: D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis*; D002097:C-Reactive Protein; D006801:Humans; D011379:Prognosis; D020127:Recovery of Function; D020521:Stroke / Q000097:blood* / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: C-reactive protein; CRP; Functional recovery; Ischemic stroke; Neuroimaging; Outcome after stroke; Prognosis