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

Abstract

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.

Keywords:

• C-reactive protein
• large-artery atherosclerosis
• small-artery occlusion
• outcome
• stroke

Abbreviations:

• CI: confidence interval
• HbA1c: hemoglobin A1c
• HDL-C: High-Density Lipoprotein Cholesterol
• hs-CRP: High-Sensitivity C-Reactive Protein
• LAA: large-artery atherosclerosis
• LDL-C: Low-Density Lipoprotein Cholesterol
• mRS: modified Rankin scale
• NIHSS: National Institutes of Health Stroke Scale
• OR: odds ratio
• ROC: receiver operating characteristics
• SAO: Small-artery occlusion
• TOAST: Trial of ORG10172 in Acute Stroke Treatment
• TC: Total Cholesterol
• TG: Triglycerides

Authors’ contributions

JW took part in design of the study, funding obtained, interpretation of the data and revising the manuscript. DH, JL, YG, and YW carried out the studies, participated in collecting data. DH and JL drafted the manuscript. RF and YG performed the statistical analysis and participated in its design. All authors read and approved the final manuscript.

Disclosure statement

All authors declare that they have no competing interests.

Ethics approval and consent to participate

This study was conducted according to the Helsinki II Declaration and approved by the ethics committee of Tianjin Huanhu Hospital. Written informed consent was obtained from all individual participants included in the study.

Funding

This study was generously supported by Grants from General Administration of Sport of China [grant number 2015B098, to J.W], and Tianjin Public Health Bureau [grant number 2013KG122, to J.W].

Acknowledgments

The authors acknowledge the invaluable participation of the patients.