Plasma C-Reactive Protein and Clinical Outcomes after Acute Ischemic Stroke: A Prospective Observational Study

Background and PurposeAlthough plasma C-reactive protein (CRP) is elevated in response to inflammation caused by brain infarction, the association of CRP with clinical outcomes after acute ischemic stroke remains uncertain. This study examined whether plasma high-sensitivity CRP (hsCRP) levels at onset were associated with clinical outcomes after acute ischemic stroke independent of conventional risk factors and acute infections after stroke.MethodsWe prospectively included 3653 patients with first-ever ischemic stroke who had been functionally independent and were hospitalized within 24 h of onset. Plasma hsCRP levels were measured on admission and categorized into quartiles. The association between hsCRP levels and clinical outcomes, including neurological improvement, neurological deterioration, and poor functional outcome (modified Rankin scale ≥3 at 3 months), were investigated using a logistic regression analysis.ResultsHigher hsCRP levels were significantly associated with unfavorable outcomes after adjusting for age, sex, baseline National Institutes of Health Stroke Scale score, stroke subtype, conventional risk factors, intravenous thrombolysis and endovascular therapy, and acute infections during hospitalization (multivariate-adjusted odds ratios [95% confidence interval] in the highest quartile versus the lowest quartile as a reference: 0.80 [0.65–0.97] for neurological improvement, 1.72 [1.26–2.34] for neurological deterioration, and 2.03 [1.55–2.67] for a poor functional outcome). These associations were unchanged after excluding patients with infectious diseases occurring during hospitalization, or those with stroke recurrence or death. These trends were similar irrespective of stroke subtypes or baseline stroke severity, but more marked in patients aged heterogeneity = 0.001).ConclusionsHigh plasma hsCRP is independently associated with unfavorable clinical outcomes after acute ischemic stroke.

背景与目的 尽管血浆C反应蛋白（C-reactive protein, CRP）可因脑梗死引发的炎症反应而升高，但CRP与急性缺血性卒中后的临床结局之间的关联仍未明确。本研究旨在探讨发病时的血浆高敏C反应蛋白（high-sensitivity CRP, hsCRP）水平是否与急性缺血性卒中后的临床结局存在独立关联，且该关联不受传统危险因素及卒中后急性感染的影响。
方法 本研究前瞻性纳入3653例首次发生缺血性卒中的患者，所有患者发病前功能独立，且于发病后24小时内住院治疗。于入院时检测血浆hsCRP水平，并将其按四分位数分组。采用logistic回归分析，探讨hsCRP水平与各项临床结局的关联，包括神经功能改善、神经功能恶化，以及3个月时改良Rankin量表评分≥3的不良功能结局。
结果 在校正年龄、性别、基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评分、卒中亚型、传统危险因素、静脉溶栓与血管内治疗，以及住院期间急性感染等混杂因素后，较高的hsCRP水平与不良临床结局显著相关：以最低四分位组为参照，最高四分位组的多变量校正比值比（95%置信区间）分别为：神经功能改善0.80（95%CI：0.65~0.97），神经功能恶化1.72（95%CI：1.26~2.34），不良功能结局2.03（95%CI：1.55~2.67）。在排除住院期间发生感染性疾病、卒中复发或死亡的患者后，上述关联未发生显著变化。无论卒中亚型或基线卒中严重程度如何，该趋势均保持一致，但在老年患者中更为显著（组间异质性P=0.001）。
结论 血浆高浓度hsCRP与急性缺血性卒中后的不良临床结局存在独立相关性。