Monomeric C-Reactive Protein and Cerebral Hemorrhage: From Bench to Bedside.

Mario Di Napoli,Mark Slevin,Simona Lattanzi,Afshin A Divani,Puneetpal Singh,Aurel Popa-Wagner

doi:10.3389/fimmu.2018.01921

Abstract

C-reactive protein (CRP) is an important mediator and a hallmark of the acute-phase response to inflammation. High-sensitivity assays that accurately measure levels of CRP have been recommended for use in risk assessment in ischemic stroke patients. Elevation of CRP during the acute-phase response in intracerebral hemorrhage (ICH) is also associated with the outcomes such as death and vascular complications. However, no association has been found with the increased risk of ICH. The aim of this review is to synthesize the published literature on the associations of CRP with acute ICH both as a risk biomarker and predictor of short- and long-term outcomes as well as its role as a pathogenic determinant. We believe before any clinical utility, a critical appraisal of the strengths and deficiencies of the accumulated evidence is required both to evaluate the current state of knowledge and to improve the design of future clinical studies.

Highlights

Inflammation is recognized to play a major role in the pathogenesis of cerebrovascular disease [1, 2]
Results of this study showed that C-reactive protein (CRP) levels were increased significantly in hemorrhagic stroke patients (p < 0.001) when compared with controls, but the CRP gene polymorphism was not found to be associated with hemorrhagic stroke
The values of CRP concentrations for the prediction of intracerebral hemorrhage (ICH) prognosis have been recognized in a variety of ethnic groups with conflicting results, so there is a possibility that it predicts different ICH phenotypes in different populations

Summary

INTRODUCTION

Inflammation is recognized to play a major role in the pathogenesis of cerebrovascular disease [1, 2]. C-reactive protein (CRP), which is produced in the liver, is a hallmark of the acute inflammatory response, and represents an extensively studied systemic marker of inflammation [3]. The significance of elevated CRP as a marker of inflammation in the clinical setting has been suggested in the literature [4,5,6]. Over recent decades CRP has been the focus of an intense investigation to explore its role in the setting of intracerebral hemorrhage (ICH) and currently is proposed as a risk assessment tool and prognostic marker [7]. The aim of this review is to synthesize the available literature examining the association of monomeric CRP with acute ICH as a risk assessment biomarker and predictor of short- and long-term outcomes as well as its role as a pathogenic determinant

STRUCTURE AND FUNCTION OF CRP

ROLE OF CRP IN INFLAMMATION

CEREBRAL HEMORRHAGE AND GENETICS OF CRP

Chinese Indian

CONCLUSIONS