C-reactive protein in the detection of post-stroke infections: systematic review and individual participant data analysis.
We conducted a systematic review and individual participant data meta-analysis to explore the role of C-reactive protein (CRP) in early detection or prediction of post-stroke infections. CRP, an acute-phase reactant binds to the phosphocholine expressed on the surface of dead or dying cells and some bacteria, thereby activating complement and promoting phagocytosis by macrophages. We searched PubMed up to May-2015 for studies measuring CRP in stroke and evaluating post-stroke infections. Individual participants' data were merged into a single database. CRP levels were standardized and divided into quartiles. Factors independently associated with post-stroke infections were determined by logistic regression analysis and the additional predictive value of CRP was assessed by comparing areas under receiver operating characteristic curves and integrated discrimination improvement index. Data from seven studies including 699 patients were obtained. Standardized CRP levels were higher in patients with post-stroke infections beyond 24 h. Standardized CRP levels in the fourth quartile were independently associated with infection in two different logistic regression models, model 1 [stroke severity and dysphagia, odds ratio = 9.70 (3.10-30.41)] and model 2 [age, sex, and stroke severity, odds ratio = 3.21 (1.93-5.32)]. Addition of CRP improved discrimination in both models [integrated discrimination improvement = 9.83% (0.89-18.77) and 5.31% (2.83-7.79), respectively], but accuracy was only improved for model 1 (area under the curve 0.806-0.874, p = 0.036). In this study, CRP was independently associated with development of post-stroke infections, with the optimal time-window for measurement at 24-48 h. However, its additional predictive value is moderate over clinical information. Combination with other biomarkers in a panel seems a promising strategy for future studies.
Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Alejandro
0000-0003-4390-8900
A
Bustamante
Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Andrea
A
Vilar-Bergua
Department of Neurology, Centre Hospitalo-Universitaire Côte de Nacre, Université Caen-Normandie, Caen, France.
Sophie
S
Guettier
Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Josep
J
Sánchez-Poblet
Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Teresa
T
García-Berrocoso
Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Dolors
D
Giralt
Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
Felix
F
Fluri
Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
Raffi
R
Topakian
Department of Neurology, Hannover Medical School, Hannover, Germany.
Hans
H
Worthmann
Spinal Cord Injury Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany.
Andreas
A
Hug
Department of Anesthesiology and Intensive Care, University of Pecs, Pecs, Hungary.
Tihamer
T
Molnar
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Ulrike
U
Waje-Andreassen
Department of Neurology, University Hospital of Zurich, Switzerland.
Mira
M
Katan
Greater Manchester Comprehensive Stroke Centre and Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
Craig J
CJ
Smith
Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Joan
J
Montaner
D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D003141:Communicable Diseases / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D013223:Statistics as Topic / Q000379:methods; D020521:Stroke / Q000097:blood* / Q000150:complications / Q000175:diagnosis
D015415:Biomarkers; D002097:C-Reactive Protein
C-reactive protein; biomarkers; individual participant data meta-analysis; infections; stroke; systematic review