The role of high-sensitivity C-reactive protein levels in functional outcomes in patients with large-artery atherosclerosis and small-artery occlusion.

BACKGROUND

High-sensitivity C-reactive protein (hs-CRP) is an inflammatory marker that is associated with the outcomes of ischemic stroke. However, the role of hs-CRP levels in the functional outcomes after large-artery atherosclerosis (LAA) and small-artery occlusion (SAO) is poorly understood.

METHODS

We recruited 1299 patients diagnosed as having LAA and 453 patients diagnosed as having SAO from 1 January 2009 to 31 December 2013, from the Department of Neurology, Tianjin Huanhu Hospital. The hs-CRP values were classified into two groups based on the significant threshold of hs-CRP level in the receiver operating characteristic (ROC) curve (≥3.215 mg/L in LAA and ≥1.72 mg/L in SAO). We examined the relationship between hs-CRP levels on admission and the modified Rankin scale scores using univariate and multivariate analyses.

RESULTS

Patients with LAA had a higher hs-CRP mean value than patients with SAO (7.69 vs. 4.12 mg/L). The ROC curve showed a significant hs-CRP threshold value at 3.215 mg/L in patients with LAA and at 1.72 mg/L in patients with SAO. Logistic regression analyses showed that patients with LAA with hs-CRP levels ≥3.215 mg/L had a significant risk of poor outcome compared with those with hs-CRP levels <3.215 mg/L (odds ratio [OR], 1.545; 95% confidence interval [CI], 1.155-2.067; p = 0.003). Meanwhile, patients with SAO with hs-CRP levels ≥1.72 mg/L had a significant risk of poor outcome compared with those with hs-CRP levels <1.72 mg/L (OR, 1.97; 95% CI, 1.02-3.801; p = 0.043). Moreover, combining hs-CRP with National Institutes of Health Stroke Scale could predict outcome with satisfying clinical accuracy both in LAA and SAO subtype.

CONCLUSIONS

Patients with LAA with hs-CRP levels <3.215 mg/L and patients with SAO with hs-CRP levels <1.72 mg/L on admission had favorable functional outcomes at 3 months after stroke onset.