(Stroke. 1999;30:981-985.)
© 1999 American Heart Association, Inc.
Original Contributions |
C-Reactive Protein and Outcome After Ischemic Stroke
From the Acute Stroke Unit, University Department of Medicine and Therapeutics (K.W.M., C.J.W., I.B.S., K.R.L.), and Department of Immunology (W.A.), Western Infirmary; and Robertson Centre for Biostatistics, University of Glasgow (C.J.W.), Glasgow, Scotland.
Correspondence to Dr Keith W. Muir, Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, Scotland. E-mail k.muir{at}clinmed.gla.ac.uk
Background and Purpose—Elevated concentrations of the acute-phase reactant C-reactive protein (CRP) predict ischemic cardiac events in both hospital- and population-based studies and may signify a role for inflammation in the destabilization of cardiovascular disease. We examined the relationship between CRP and outcome after acute ischemic stroke.
Methods—This was a subgroup analysis from a prospective
observational study based in a University Hospital Acute Stroke Unit
serving a population of 
260 000. Survival time and cause of death
for up to 4 years after the index stroke were determined and related to
CRP concentration within 72 hours of stroke and known prognostic
variables by a Cox proportional hazards regression model.
Results—Ischemic stroke was diagnosed in 228 of 283
consecutive admissions. Median follow-up was 959 days. Geometric mean
CRP concentration was 10.1 mg/L. Survival in those with CRP >10.1 mg/L
was significantly worse than in those with CRP 
10.1 mg/L
(P=0.00009, log-rank test). Higher CRP concentration was
an independent predictor of mortality (hazard ratio, 1.23 per
additional natural log unit; 95% CI, 1.13 to 1.35;
P=0.02), together with age and stroke severity on the
National Institutes of Health Stroke Scale.
Cardiovascular disease accounted for 76% of deaths in
those with CRP >10.1 mg/L and 63% of deaths in those with CRP 10.1
mg/L.
Conclusions—CRP concentration is an independent predictor of survival after ischemic stroke. These findings are consistent with a role for inflammation in acute ischemic stroke, as well as with the hypothesis that elevated CRP may predict future cardiovascular mortality.
Key Words: acute-phase reaction • cerebrovascular disorders • C-reactive protein • inflammation • prognosis
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