Abstract 3917: High-sensitivity C reactive Protein Levels Predict Infarct Growth in Acute Ischemic Stroke

Abstract

Objectives: There is controversy over whether the inflammatory biomarkers detected after focal cerebral ischemia represent a mechanism of tissue injury or simply reflects the extent of ischemic brain injury. In this study we sought to establish whether levels of an inflammatory biomarker (high sensitivity c-reactive protein, hs-CRP) correlate with and predict infarct growth. Methods: We prospectively measured hs-CRP in consecutive acute stroke patients (<9 hours from symptom onset) in a multicenter acute ischemic stroke biomarker study. Clinical and demographic data including NIHSS scores at baseline, 48 hours, and discharge, stroke subtype, imaging, and 3 month mRS were collected. Patients with acute infection, active malignancy, or systemic inflammatory disorder were excluded. Infarct growth (IG) was defined as the difference between baseline and t48 hour DWI infarct volume. Multivariate logistic regression model was used to adjust for the effects of potential confounding variables. Results: Of 528 subjects enrolled in the biomarker study we included 220 patients with IG, mean age 74 (s.d. 13.8), for whom imaging data were available, in the analysis. The mean IG was 39.9 (s.d.66) cc. We identified cut-off values of IG based on quartiles 50 percentile (15 cc). Subject with IG were more likely to be older, have a higher baseline NIHSS score, a history of carotid stenosis or AF, an anterior circulation stroke, a large vessel occlusion, and larger baseline MTT perfusion deficit. Subjects with IG ≥15cc had a higher mean hs-CRP levels at 48 hours compared to those with an IG <15cc (41.7 mg/L, s.d. 49.6 vs 23 mg/L s.d. 37.7, p=0.011). At multivariate analyses after adjustment for all the confounding variables, 48-hour hsCRP remained independenttly correlated with IG≥15cc. Conclusions: High 48 hour levels of hs-CRP were independently associated with larger IG in acute ischemic stroke patients. Hence, if validated, high hs-CRP might be helpful in routine clinical practice to monitor infarct growth and could become a valuable specific surrogate marker of stroke progression.