Abstract
The possible role of C-reactive protein (CRP) in the etiology and prognosis of ischemic
stroke remains to be clearly defined. The purpose of this study was to determine whether
CRP levels are elevated in patients with stroke, whether they remain persistently
elevated, and whether CRP levels are higher in patients with etiologic subtypes of
stroke caused by large or small artery disease (“atherogenic hypothesis”) or whether
they may be higher in patients with more extensive cerebral infarction caused by large
artery or cardiogenic embolism (“inflammatory hypothesis”). We conducted a case-control
study of 199 hospital cases with a first-ever ischemic stroke and 202 randomly selected
community controls. Cases of stroke were classified by etiologic subtype and the prevalence
of conventional vascular risk factors and CRP levels were determined in cases and
controls. Blood levels of CRP measured within 7 days of acute stroke were significantly
higher in cases compared with controls (8.50 vs. 2.18 mg/L, P <.0001) and remained elevated in stroke survivors at 3 to 6 months of follow-up (3.35
vs. 2.18 mg/L, P =.003) although levels were significantly lower compared with the first 7 days (3.35
vs. 8.50 mg/L, P <.001-.003). Compared with the lowest quartile of CRP, the upper 3 quartiles were
associated with an adjusted odds ratio (OR) of ischemic stroke of 1.9 (95% CI: 1.0-3.8)
for the second quartile, 5.8 (95% CI: 2.9-11.4) for the third quartile, and 16.9 (95%
CI: 7.9-36.1) for the fourth quartile (P for trend <.0001). Comparing the upper with the lower quartile, the strongest association
was with etiologic stroke subtypes caused by large artery disease (OR 52.5; 95% CI:
13.4-205) and embolism from the heart (OR 56.1; 95% CI: 11.3-278), with a much weaker
association with small artery disease (OR 2.4; 95% CI: 0.8-6.0). The mean Oxford Handicap
Scale score was lowest in small artery, intermediate in large artery and highest in
cardioembolic stroke (2.8 vs. 3.1 vs. 3.6, respectively; P =.001) while the mean Barthel Index was highest in small artery, intermediate in
large artery, and lowest in cardioembolic stroke (13.5 vs. 11.5 vs. 8.6, respectively;
P =.002). Furthermore, there was a significant correlation between CRP levels during
the first 7 days and stroke severity, as measured by the Oxford Handicap Scale score
(P =.03) and Barthel index (P =.001). We conclude that there is a strong, independent relationship between elevated
blood levels of CRP and ischemic stroke, particularly because of more severe strokes
caused by large artery disease and embolism from the heart, which remains evident
over the long term. These results are consistent with the inflammatory marker hypothesis
of CRP as a marker of the extent of ischemic cerebral injury and its complications.
Copyright © 2003 by National Stroke Association.
Keywords
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Article info
Publication history
Accepted:
January 14,
2003
Received:
November 4,
2002
Footnotes
*Supported by grants from the Royal Perth Hospital Medical Research Foundation and the National Heart Foundation of Australia.
**Address reprint requests to John W. Eikelboom, Department of Hematology, Royal Perth Hospital, Box X2213 GPO, Perth WA 6897, Australia. E-mail: [email protected]
★1052-3057/03/1202-0001$30.00/0
Identification
Copyright
© 2003 National Stroke Association. Published by Elsevier Inc. All rights reserved.
