Abstract TP61: Elevated CRP Between Day 1 And 7 and not Admission CRP Is An Independent Predictor For Outcome at 3 Months In Thrombolized Acute Stroke Patients

Abstract

Background: The value of CRP in stroke patients undergoing thrombolysis, in the acute and subacute phase of ischemic stroke as a prognostic tool for outcome is unclear, since conflicting reports exist. Aim of our study was to explore the role of admission CRP and follow-up CRP between day 1 and 7, for outcome and mortality in stroke patients treated with rtPa. Methods: From March 1998 to 2011 all patients admitted to our hospital and undergoing thrombolysis for acute ischemic stroke were included into an open, prospective database. Stroke severity was assessed using the NIHSS. In all patients CRP levels was measured upon admission in the emergency room, after 24 hours from the acute event and in the following days. CT scan before treatment and routine brain CT scan 24-36 h after thrombolysis were performed. Symptomatic haemorrhage (sICH) was defined according to ECASS II criteria. Functional outcome was assed by mRS at three months and divided into independent (mRS0-2) and dependent (mRS 3-5). Results: In total, 1292 patients were registered in our database. About 70% of patients had an increase of CRP values in the first 7 days after admission. Infection occurred in 22% of patients and about 25% had a large brain infarction (>1/3 of vessel territory). sICH occurred in 6.7% of patients. Follow-up CRP levels between day 1 and 7 were significantly associated with cardio embolic stroke (p=0.033), infarct size (p<0.001), infection (p<0.001), symptomatic haemorrhage (p<0.001), independent (p<0.001), dependent outcome (p<0.001) and mortality (p<0.001). CRP values between day 1 and 7 (OR 2.824 CI95%; 1.534 - 5.201, p=0.001), infarct size (OR 2.254; CI95% 1.480 - 3.432, p<0.001), infection (OR1.752; CI95% 1.100 - 2.789, p=0.018) and NIHSS (OR 1.043; CI95% 1.016 - 1.069, p=0.001) were independent predictors for dependent outcome. Admission CRP values were not independently associated with outcome and mortality after multivariate logistic regression analysis. Conclusion: Together with know predictors like infarct size, NIHSS and infections, maximally elevated CRP levels within day 1 and 7 were strongly and independently associated with long-term outcome in thrombolyzed stroke patients after correction for baseline variables.