The role of very high high-sensitivity C-reactive protein levels on mortality after stroke

- hsCRP > 10 mg/L independently predict mortality in patients with acute stroke.
- The effect of hsCRP > 10 mg/L on mortality is attenuated with higher stroke severity.
- Very high levels of hsCRP may serve as a marker of general illness.

High-sensitivity C-reaction protein (hsCRP) levels are correlated with risk of vascular disease. The clinical implications of markedly elevated hsCRP levels in the setting of acute stroke are less understood.ObjectiveTo determine the association of very high admission hsCRP levels (≥ 10 mg/L) on all-cause mortality in patients with acute stroke.MethodsA retrospective cohort study of 1176 patients hospitalized with acute stroke between 2005 and 2012 who had a hsCRP assay drawn within seven days of admission. Mortality data was obtained using Ohio Death Index. 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 relevant co-morbid conditions. NIHSS was also adjusted in a subset of patients in whom it was available (n = 378).ResultsPatients with hsCRP > 10 mg/L had 2.65 (95% CI: 1.99, 3.53) increased hazard of all-cause mortality compared to stroke patients with hsCRP ≤ 10 mg/L. Association of hsCRP with mortality was greater for patients with low NIHSS and declined in patients with increasing NIHSS scores. A higher proportion of patients with hsCRP > 10 died from nonvascular causes than patients with hsCRP ≤ 10 mg/L.ConclusionVery high levels of hsCRP may be a useful marker to identify stroke patients at increased risk for death, especially those with stroke of mild severity. More research is needed to determine how this information can be used to improve patient care, especially in patients with mild stroke.