Is there a prognostic role for C‐reactive protein in ischemic stroke?

Corso G, Bottacchi E, Brusa A, Di Benedetto M, Giardini G, Lia C, Reggiani M, Veronese Morosini M. Is there a prognostic role for C-reactive protein in ischemic stroke? Acta Neurol Scand: 122: 209–216. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives –  We investigated the relationship between C-reactive protein (CRP)-values in the acute phase of stroke and the risk of further fatal and non-fatal ischemic events. Materials and methods –  We analysed 462 consecutive incident ischemic strokes. Patients were divided into two subgroups on the basis of a CRP cut-off level of 9 mg/l. Primary end points were any new vascular fatal and non-fatal event recorded during the follow-up period. Results –  During a follow-up of 2.27 years, in 132 patients occurred a primary end point. Patients with CRP values ≥9 mg/l had more frequently primary end point. The hazard ratio (HR) for cardiovascular events was 3.59; 1.93 for cerebrovascular events; 7.43 for vascular deaths and 5.78 for death from any cause. Cox proportional hazard multivariate analysis identified CRP values ≥9 (HR = 4.19, 95% CI: 1.85–9.50, P = 0.001), the lack of secondary prevention therapy at discharge (HR = 4.35, 95% CI: 1.87–10.1, P = 0.001), age >70 years (HR = 3.09, 95% CI: 1.04–9.24, P = 0.04) as independent predictors of fatal events. Conclusions –  CRP levels ≥9 mg/l, evaluated in incident ischemic stroke within 24 h, predict a higher risk of further ischemic events and mortality.