title: Follow-up C-reactive protein level is more strongly associated with outcome in stroke patients than admission levels.
abstract: The value of C-reactive protein (CRP) as a prognostic tool in stroke patients is unclear. The aim of this study is to explore the prognostic impact of CRP levels assessed at different time points on functional outcome in a large cohort of thrombolysed acute stroke patients. All thrombolysed stroke patients admitted to our department were entered in an open, prospective database. Clinical and demographic data were recorded. CRP was measured upon admission, within 24 h, and in the following days. Functional outcome was assessed using the modified Rankin Scale (mRS) at 3 months. Among 1242 thrombolysed patients, we found a statistically significant difference in median CRP values upon admission, within 24 h, and follow-up with respect to outcome parameters (p < 0.001) including symptomatic intracerebral hemorrhage (sICH; p < 0.001). In regression models, follow-up CRP showed better predictive properties for outcome parameters compared to CRP assessed upon admission or within 24 h. The ROC analysis showed a good predictive value of follow-up CRP concerning dependent outcome [c-statistic 0.71 (95 % CI 0.67-0.75) p < 0.001] and mortality [c-statistic 0.70 (95 % CI 0.66-0.75) p < 0.001]. After adjustment for risk factors, follow-up CRP, but not admission CRP, was independently associated with dependent outcome (OR 2.67, 95 % CI 1.76-4.06; p < 0.001), mortality (OR 2.53, 95 % CI 1.50-4.25; p < 0.001), and sICH (OR 3.03, 95 % CI 1.51-6.06; p = 0.002). Follow-up CRP is strongly associated with functional outcome, sICH, and mortality after 90 days in thrombolysed stroke patients.
authors.affiliation: Center for Stroke Research, Charite-University Medical Centre, Berlin, Germany. andrea.rocco@charite.de.|Department of Neurology, Charite University of Berlin, Hindenburgdamm 30, 12203, Berlin, Germany. andrea.rocco@charite.de.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rocco
authors.affiliation: Department of Neurology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ringleb
authors.affiliation: Center for Stroke Research, Charite-University Medical Centre, Berlin, Germany.|Department for Biostatistics and Clinical Epidemiology, Charite-University Medical Centre Berlin, Berlin, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Grittner
authors.affiliation: Center for Stroke Research, Charite-University Medical Centre, Berlin, Germany.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
authors.affiliation: Center for Stroke Research, Charite-University Medical Centre, Berlin, Germany.
authors.forename: Alice
authors.initials: A
authors.lastname: Schneider
authors.affiliation: Department of Neurology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Nagel
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000378:metabolism* / Q000628:therapy; D015912:Thrombolytic Therapy
chemical_list: D002097:C-Reactive Protein
keywords: CRP; Mortality; Outcome; Stroke; Thrombolysis