Login Register Cart 0
Generic placeholder image

Current Neurovascular Research

Editor-in-Chief

ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Association of High-sensitivity C-reactive Protein with Patient Prognosis Following Mechanical Thrombectomy for Acute Ischemic Stroke

Author(s): Seonggon Kim, Ho J. Yi*, Dong H. Lee and Jae H. Sung

Volume 17, Issue 4, 2020

Page: [402 - 410] Pages: 9

DOI: 10.2174/1567202617666200517110949

Price: $65

Abstract

Objective: The aim of this investigation was to examine the association of hsCRP (highsensitivity C-reactive protein) with outcomes and prognosis of patients who underwent mechanical thrombectomy (MT) for large vessel occlusion (LVO) after acute ischemic stroke (AIS).

Methods: A total of 404 patients were enrolled, and outcomes included unfavorable clinical outcome at three months (modified Rankin Scale, mRS scores 3-6), the occurrence of symptomatic intracerebral hemorrhage (sICH) and hemorrhagic transformation (HT) of the infarct. Receiver operating characteristic (ROC) curve analysis was performed to identify the cutoff value of hsCRP to discriminate between favorable and unfavorable outcomes. The association of hsCRP with outcomes was evaluated using a logistic regression model.

Results: The best cutoff value of hsCRP to distinguish between favorable and unfavorable outcomes at three months was identified as 3.0 mg/L (area under the curve, [AUC] 0.641, 95% confidence interval, [CI] 0.535-0.748; P = 0.014). In, multivariate analysis, patients with hsCRP ≥3 mg/L had more unfavorable outcome (odds ratio [OR] 1.72, 95% CI 1.42-2.02; P = 0.010), sICH (OR 2.64, 95% CI 1.62-3.66; P = 0.004), and HT of infarct (OR 1.72, 95% CI 1.42-2.02; P = 0.008) compared to those with hsCRP <1 mg/L.

Conclusion: Our study demonstrates that patients with higher CRP levels had more unfavorable outcome, and exhibited higher sICH, and HT of infarct than those with lower CRP levels. Elevated hsCRP level, especially when higher than 3 mg/L, is an independent predictor for poor clinical prognosis in patients with MT for LVO.

Keywords: C-reactive protein, cerebral hemorrhage, inflammation, ischemic stroke, prognosis, thrombectomy.

« Previous Next »
[1]
Elkind MS, Leon V, Moon YP, Paik MC, Sacco RL. High-sensitivity C-reactive protein and lipoprotein-associated phospholipase A2 stability before and after stroke and myocardial infarction. Stroke 2009; 40(10): 3233-7.
[http://dx.doi.org/10.1161/STROKEAHA.109.552802] [PMID: 19644070]
[2]
Elkind MS. Inflammation, atherosclerosis, and stroke. Neurologist 2006; 12(3): 140-8.
[http://dx.doi.org/10.1097/01.nrl.0000215789.70804.b0] [PMID: 16688015]
[3]
Packard RR, Libby P. Inflammation in atherosclerosis: From vascular biology to biomarker discovery and risk prediction. Clin Chem 2008; 54(1): 24-38.
[http://dx.doi.org/10.1373/clinchem.2007.097360] [PMID: 18160725]
[4]
Xu R, Zhang Y, Gao X, Wan Y, Fan Z. High-sensitivity CRP (C-Reactive Protein) is associated with incident carotid artery plaque in chinese aged adults. Stroke 2019; 50(7): 1655-60.
[http://dx.doi.org/10.1161/STROKEAHA.119.025101] [PMID: 31195938]
[5]
Soeki T, Sata M. Inflammatory biomarkers and atherosclerosis. Int Heart J 2016; 57(2): 134-9.
[http://dx.doi.org/10.1536/ihj.15-346] [PMID: 26973275]
[6]
Wu L, Xiong X, Wu X, et al. Targeting oxidative stress and inflammation to prevent ischemia-reperfusion injury. Front Mol Neurosci 2020; 13: 28.
[http://dx.doi.org/10.3389/fnmol.2020.00028] [PMID: 32194375]
[7]
Li L, Liu QW, Li Z, et al. The utility of high-sensitivity C-reactive protein levels in patients with moderate coronary lesions and gray-zone fractional flow reserve. Anatol J Cardiol 2018; 20(3): 143-51.
[PMID: 30109863]
[8]
Elkind MS, Luna JM, McClure LA, et al. LIMITS Investigators. C-reactive protein as a prognostic marker after lacunar stroke: Levels of inflammatory markers in the treatment of stroke study. Stroke 2014; 45(3): 707-16.
[http://dx.doi.org/10.1161/STROKEAHA.113.004562] [PMID: 24523037]
[9]
Li J, Zhao X, Meng X, et al. CHANCE Investigators High-sensitive C-reactive protein predicts recurrent stroke and poor functional outcome: Subanalysis of the clopidogrel in high-risk patients with acute nondisabling cerebrovascular events trial. Stroke 2016; 47(8): 2025-30.
[http://dx.doi.org/10.1161/STROKEAHA.116.012901] [PMID: 27328699]
[10]
Park DW, Yun SC, Lee JY, et al. C-reactive protein and the risk of stent thrombosis and cardiovascular events after drug-eluting stent implantation. Circulation 2009; 120(20): 1987-95.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.876763] [PMID: 19884467]
[11]
Segal HC, Burgess AI, Poole DL, Mehta Z, Silver LE, Rothwell PM. Population-based study of blood biomarkers in prediction of subacute recurrent stroke. Stroke 2014; 45(10): 2912-7.
[http://dx.doi.org/10.1161/STROKEAHA.114.005592] [PMID: 25158774]
[12]
Arenillas JF, Alvarez-Sabín J, Molina CA, et al. C-reactive protein predicts further ischemic events in first-ever transient ischemic attack or stroke patients with intracranial large-artery occlusive disease. Stroke 2003; 34(10): 2463-8.
[http://dx.doi.org/10.1161/01.STR.0000089920.93927.A7] [PMID: 14500938]
[13]
Woodward M, Lowe GD, Campbell DJ, et al. Associations of inflammatory and hemostatic variables with the risk of recurrent stroke. Stroke 2005; 36(10): 2143-7.
[http://dx.doi.org/10.1161/01.STR.0000181754.38408.4c] [PMID: 16151030]
[14]
Dirks M, Niessen LW, van Wijngaarden JD, et al. PRomoting ACute Thrombolysis in Ischemic StrokE (PRACTISE) Investigators. Promoting thrombolysis in acute ischemic stroke. Stroke 2011; 42(5): 1325-30.
[http://dx.doi.org/10.1161/STROKEAHA.110.596940] [PMID: 21393587]
[15]
Goyal M, Menon BK, van Zwam WH, et al. HERMES collaborators Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387(10029): 1723-31.
[http://dx.doi.org/10.1016/S0140-6736(16)00163-X] [PMID: 26898852]
[16]
Berkhemer OA, Fransen PS, Beumer D, et al. MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372(1): 11-20.
[http://dx.doi.org/10.1056/NEJMoa1411587] [PMID: 25517348]
[17]
Campbell BC, Mitchell PJ, Kleinig TJ, et al. EXTEND-IA Investigators Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372(11): 1009-18.
[http://dx.doi.org/10.1056/NEJMoa1414792] [PMID: 25671797]
[18]
Goyal M, Demchuk AM, Menon BK, et al. ESCAPE Trial Investigators Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372(11): 1019-30.
[http://dx.doi.org/10.1056/NEJMoa1414905] [PMID: 25671798]
[19]
Jovin TG, Chamorro A, Cobo E, et al. REVASCAT Trial Investigators Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372(24): 2296-306.
[http://dx.doi.org/10.1056/NEJMoa1503780] [PMID: 25882510]
[20]
Saver JL, Goyal M, Bonafe A, et al. SWIFT PRIME Investigators Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372(24): 2285-95.
[http://dx.doi.org/10.1056/NEJMoa1415061] [PMID: 25882376]
[21]
Yi HJ, Sung JH, Lee DH. Bridging intravenous thrombolysis before mechanical thrombectomy for large artery occlusion may be detrimental with thrombus fragmentation. Curr Neurovasc Res 2020; 17(1): 18-26.
[http://dx.doi.org/10.2174/1567202617666191223143831] [PMID: 31870263]
[22]
Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subtypes. Cerebrovasc Dis 2009; 27(5): 493-501.
[http://dx.doi.org/10.1159/000210432] [PMID: 19342825]
[23]
Yi HJ, Sung JH, Lee DH, Yang SH, Hong JT. A useful diagnostic method to reduce the in-hospital time delay for mechanical throm-bectomy: Volume perfusion computed tomography with added vessel reconstruction. J Neurosurg 2018. Epub ahead of print
[http://dx.doi.org/10.3171/2017.10.JNS171971] [PMID: 29652229]
[24]
Humphries W, Hoit D, Doss VT, et al. Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg 2015; 7(2): 90-4.
[http://dx.doi.org/10.1136/neurintsurg-2013-010986] [PMID: 24463439]
[25]
Hacke W, Kaste M, Bluhmki E, et al. ECASS Investigators Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359(13): 1317-29.
[http://dx.doi.org/10.1056/NEJMoa0804656] [PMID: 18815396]
[26]
Pearson TA, Mensah GA, Alexander RW, et al. Centers for Disease Control and Prevention, American Heart Association. Markers of inflammation and cardiovascular disease: Application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107(3): 499-511.
[http://dx.doi.org/10.1161/01.CIR.0000052939.59093.45] [PMID: 12551878]
[27]
Kaptoge S, Di Angelantonio E, Lowe G, et al. Emerging Risk Factors Collaboration. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: An individual participant meta-analysis. Lancet 2010; 375(9709): 132-40.
[http://dx.doi.org/10.1016/S0140-6736(09)61717-7] [PMID: 20031199]
[28]
Kosmidou I, Redfors B, Chen S, et al. C-reactive protein and prognosis after percutaneous coronary intervention and bypass graft surgery for left main coronary artery disease: Analysis from the EXCEL trial. Am Heart J 2019; 210: 49-57.
[http://dx.doi.org/10.1016/j.ahj.2018.12.013] [PMID: 30738244]
[29]
Kawada-Watanabe E, Yamaguchi J, Kanbayashi K, et al. Predictive value of baseline high-sensitivity C-reactive protein level and renal function for patients with acute coronary syndrome undergoing aggressive lipid-lowering therapy: A subanalysis of HIJ-PROPER. Am J Cardiol 2018; 122(11): 1817-23.
[http://dx.doi.org/10.1016/j.amjcard.2018.08.028] [PMID: 30270178]
[30]
Kitagawa K, Hosomi N, Nagai Y, et al. J-STARS collaborators. Cumulative Effects of LDL Cholesterol and CRP Levels on Recurrent Stroke and TIA. J Atheroscler Thromb 2019; 26(5): 432-41.
[http://dx.doi.org/10.5551/jat.45989] [PMID: 30318492]
[31]
Zhou Y, Han W, Gong D, Man C, Fan Y. Hs-CRP in stroke: A meta-analysis. Clin Chim Acta 2016; 453: 21-7.
[http://dx.doi.org/10.1016/j.cca.2015.11.027] [PMID: 26633855]
[32]
Polak JF, Pencina MJ, Pencina KM, O’Donnell CJ, Wolf PA, D’Agostino RB Sr. Carotid-wall intima-media thickness and cardiovascular events. N Engl J Med 2011; 365(3): 213-21.
[http://dx.doi.org/10.1056/NEJMoa1012592] [PMID: 21774709]
[33]
Mathiesen EB, Johnsen SH. Ultrasonographic measurements of subclinical carotid atherosclerosis in prediction of ischemic stroke. Acta Neurol Scand Suppl 2009; (189): 68-72.
[http://dx.doi.org/10.1111/j.1600-0404.2009.01210.x] [PMID: 19566503]
[34]
Eltoft A, Arntzen KA, Hansen JB, Wilsgaard T, Mathiesen EB, Johnsen SH. C-reactive protein in atherosclerosis - A risk marker but not a causal factor? A 13-year population-based longitudinal study: The Tromsø study. Atherosclerosis 2017; 263: 293-300.
[http://dx.doi.org/10.1016/j.atherosclerosis.2017.07.001] [PMID: 28728065]
[35]
Di Napoli M, Parry-Jones AR, Smith CJ, et al. C-reactive protein predicts hematoma growth in intracerebral hemorrhage. Stroke 2014; 45(1): 59-65.
[http://dx.doi.org/10.1161/STROKEAHA.113.001721] [PMID: 24262327]
[36]
Hassan AE, Kotta H, Shariff U, Preston L, Tekle W, Qureshi A. There is no association between the number of stent retriever passes and the incidence of hemorrhagic transformation for patients undergoing mechanical thrombectomy. Front Neurol 2019; 10: 818.
[http://dx.doi.org/10.3389/fneur.2019.00818] [PMID: 31440198]
[37]
Neuberger U, Kickingereder P, Schönenberger S, et al. Risk factors of intracranial hemorrhage after mechanical thrombectomy of anterior circulation ischemic stroke. Neuroradiology 2019; 61(4): 461-9.
[http://dx.doi.org/10.1007/s00234-019-02180-6] [PMID: 30778621]
[38]
Ridker PM, Danielson E, Fonseca FA, et al. JUPITER Study Group Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008; 359(21): 2195-207.
[http://dx.doi.org/10.1056/NEJMoa0807646] [PMID: 18997196]
[39]
Qu X, Shi J, Cao Y, Zhang M, Xu J. Prognostic value of white blood cell counts and c-reactive protein in acute ischemic stroke patients after intravenous thrombolysis. Curr Neurovasc Res 2018; 15(1): 10-7.
[http://dx.doi.org/10.2174/1567202615666180326101524] [PMID: 29577860]
[40]
Liao JK. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. Curr Atheroscler Rep 2009; 11(4): 243-4.
[http://dx.doi.org/10.1007/s11883-009-0037-3] [PMID: 19500485]
[41]
Ridker PM, Cannon CP, Morrow D, et al. Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) Investigators. C-reactive protein levels and outcomes after statin therapy. N Engl J Med 2005; 352(1): 20-8.
[http://dx.doi.org/10.1056/NEJMoa042378] [PMID: 15635109]
[42]
Wang L, Li Y, Wang C, Guo W, Liu M. C-reactive protein, infection, and outcome after acute ischemic stroke: A registry and systematic review. Curr Neurovasc Res 2019; 16(5): 405-15.
[http://dx.doi.org/10.2174/1567202616666191026122011] [PMID: 31738143]
[43]
Zheng X, Zeng N, Wang A, et al. Elevated C-reactive protein and depressed high-density lipoprotein cholesterol are associated with poor function outcome after ischemic stroke. Curr Neurovasc Res 2018; 15(3): 226-33.
[http://dx.doi.org/10.2174/1567202615666180712100440] [PMID: 29998802]

Rights & Permissions Print Cite
Article Metrics
73
© 2024 Bentham Science Publishers | Privacy Policy