Abstract 3253: The Predictability of C-reactive Protein, Lipoprotein-Associated Phospholipase A2, and Depression on Later Health Outcomes in Patients Experiencing a First-Time Stroke
Background: Strokes trigger an acute inflammatory response prompted by brain tissue injury at the infarct site and the surrounding ischemic penumbra. CRP and Lp-PLA2 have been significantly correlated in some studies with infarct size and post-stroke complications, and up to 60% of stroke survivors experience depression which may contribute to poor health outcomes. We sought to examine interaction effects between baseline CRP and Lp-PLA2 levels with depression in patients with a first-ever ischemic stroke.
Methods: Baseline levels of CRP, Lp-PLA2 and depression were measured in 24 consecutive stroke patients presenting to the ED within 24 hours of symptoms onset. Depression levels, NIHSS, mRS, and quality of life (SF-36) were re-measured at 3 months post-stroke. Hierarchial multiple regression models were used to assess each outcome measure; Spearman correlations were used to reduce the number of predictor variables.
Results: The median age of the participants was 62 (range 45 - 85); 62% were male, 25% African American, and 75% Caucasian. Stroke subtypes were 62% lacunar, 4% large vessel; and 33% cardioembolic; 45% were taking a statin prior to admission and mean baseline LDL was 108.6 + 33.8mg/dL (range 66-189). Of the 24 participants enrolled, 20 completed the study. At 3 months post-stroke, 92% were taking a statin; mean LDL was 89.71. The median admission NIHSS score was 3.1 (range 0-15), and 17% were treated with IV t-PA Baseline CRP values ranged from <0.1 to 34.9 with a median of 0.3. Baseline Lp-PLA2 values ranged from 85 to 617 with a median of 194. The mean Beck Depression Inventory score on admission was 5.9 + 4.6. Neither the biological markers of CRP and Lp-PLA2 nor the interaction between CRP and Lp-PLA2 and depression were significant independent predictors of health outcomes at 3 months post-stroke. Depression, however, was a significant independent predictor of functionality (p=.009) and quality of life (p=.02) at 3 months post-stroke.
Discussion: The impact of depression on 3 month outcomes is significant. While these 2 biomarkers were unreliable at predicting health outcomes, providers should standardize their assessment of depression to ensure proper detection and treatment that may improve health outcomes post-stroke.
- © 2012 by American Heart Association, Inc.