Abstract TP226: C-reactive Protein Predicts Early Neurological Deterioration After Ischemic Stroke

Abstract

Introduction: Early neurological deterioration (END) in patients with acute stroke is associated with poorer outcomes. We aim to investigate whether higher acute phase reactants in blood are associated with END. Identifying predictors of END could help select patient at the highest risk of END for possible interventions. Methods: In this cross-sectional study, we included 242 patients with acute onset of ischemic stroke admitted to Columbia University Irving Medical Center-New York-Presbyterian Hospital from 2006 to 2015. We focused on retrieving C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) when they were collected on admission. Risk factors and comorbidities were also captured from the charts. END was defined as any neurologic deterioration referable to ischemic stroke and not related to a medical or non-cerebrovascular neurological complication. We considered significant associations by a P-value <.05. We built separate logistic regression models with END as the outcome and CRP and ESR as the main exposure variables, progressively adjusting for confounders. Results: The study included 242 patients with a mean age of 64.2 ± 17.2, of which 108 (50%) were women, 89 (41%) were Hispanic and 40 (19%) were African American or black. The prevalence of END was 47 (19%). The most common stroke mechanism was penetrating artery infarct, 103 (43%). CRP level was associated with END, and it remained an independent predictor of END even after progressively adjusting for confounders (OR = 1.01; 95% CI 1.01 to 1.02, P <0.001). ESR was not associated with END (table 1). Among patients with acute stroke and CRP>10, there was a 28% risk of END compared with only 13% among those with CRP 10 or lower. Conclusions: Our results suggest that high CRP levels are associated with END. A cutoff of 10 or greater identifies patients at the highest risk of END. Replication studies are needed to understand the mechanisms behind this and further replicate these findings.