Abstract TP180: Markedly Elevated High-sensitive C-reactive protein (hsCRP) Predicts Early Mortality Among Stroke Patients

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Background: High-sensitive C-Reactive Protein (hsCRP) levels are correlated with risk of vascular disease and cardiovascular mortality. The clinical implications of markedly elevated hsCRP levels in the setting of acute stroke are less understood as they are often excluded from studies. Objective: To determine the association of very high admission hsCRP levels (> 10mg/L) on all-cause mortality in patients with acute stroke Methods: We performed a retrospective cohort study of patients admitted to our institution with acute stroke (8/2003- 11/2011) who had at least one hsCRP assay drawn < 7 days of stroke diagnosis. Mortality data was obtained using Social Security Death Index. Differences in survival were determined using Kaplan-Meier curves. Cox proportional analysis was used to determine hazard ratios of death among patients with hsCRP values > 10 mg/L after adjusting for age, sex, race and the following co-morbid conditions: cancer, atrial fibrillation, diabetes, hypertension, myocardial infarction Results: There were 293 stroke patients identified with hsCRP levels drawn < 7 days of stroke admission. Median age was 65.7 years (SD 15.3), and 55% were male. All-cause mortality was 18% (n=53) with a median follow-up of 2.2 years. Median hsCRP level was 5.5 mg/L, [IQR 1.8 - 14.6] with 31.7% patients having hsCRP > 10 mg/L. Patients with hsCRP > 10 mg/L had a 2.7 times higher risk of mortality than those with hsCRP < 10 mg/L (p=0.004). The increased risk was steepest in the first months after stroke (Figure). The only other significant variable affecting hazard for death was age; each year increased the hazard ratio by 3.3%. Of the cases in which cause of death was known (n=31), stroke was the most common cause (71%) Conclusion: Very high level of hsCRP (>10 mg/L) at the time of admission is associated with increased early mortality among patients presenting with acute strokes. This finding may help stratify risk of death in stroke.