Академический Документы
Профессиональный Документы
Культура Документы
Abstract
Objectives: To study, the high sensitivity C-reactive protein (hsCRP) level in Indian patients with stroke and its subtypes, to evaluate
whether hsCRP levels in stroke correlate with other risk factors, and also to evaluate the hsCRP level as a prognostic marker in
cases of different types of stroke.
Material and methods: A prospective study of 40 patients presenting with a history of focal neurological deficit of acute onset in
the form of hemiparesis, hemianaesthesia, or having evidence of presence of ischaemic or haemorrhagic infarct in CT scan of
brain was done. In all patients hsCRP levels were measured within 72 hours of presentation.
Results: Most of the patients (65%) were in the age group of 50 - 70 years. Left-sided hemiparesis with altered sensorium with
facial palsy was the most common presenting symptom. hsCRP levels were found to be increased in stroke patients and on
comparison with controls, the values were found to be significant (p < 0.001). Also, the values were found to be more in haemorrhagic
than ischaemic stroke. No significant correlation was seen with other risk factors like diabetes, dyslipidaemia. It was also seen that
patient with low GCS score had high levels of hsCRP in both types of stroke. Mean hsCRP level was 14.8 6.2 in non-survivors of
haemorrhagic and 10.7 5.4 in ischaemic stroke. These values were found to be statistically significant (p < 0.001).
Conclusion: From this study we concluded that hsCRP level is increased in cases of stroke ischaemic as well as haemorrhagic,
suggesting an inflammatory response in acute stroke. Furthermore, the increased levels correlated with larger infarct and bleed,
severe neurological deficit and worse outcome.
Key words: Ischaemic stroke, haemorrhagic stroke, hsCRP level.
Introduction
Stroke is third most common cause of death in the US as
well as the leading cause of serious, long-term disability.
Two-thirds of all strokes occur in people over age 65, with
men more affected than women, although women are
more likely to die from a stroke. Attempts to modify the
traditional risk factors have not been entirely effective
in reducing national stroke rates. The acute phase
protein, i.e., high sensitivity C-reactive protein (hsCRP)
in particular, has been the most extensively studied
marker of inflammation1. It is a novel plasma marker of
atherothrombtic disease. CRP is produced not only by
the liver but also in vascular smooth muscle cells and
adipocytes. Because it is a stable protein, its
measurement is not greatly affected by the freezing
cycle. Elevated plasma levels of CRP are not disease
specific but are sensitive markers which are produced
in response to tissue injury, infectious agents, and
inflammation. hsCRP predicts the first cardiovascular
event in several populations. It was the only
* JR-III, ** Professor, *** Lecturer, Department of Medicine, **** Ex-Professor, Department of Pathology,
GSVM Medical College, Kanpur - 208022, Uttar Pradesh.
Symptoms
1.
a)
18
5
45
12.5
Right-sided weakness
with altered sensorium
b) Without altered sensorium
9
3
22.5
7.5
c)
12.5
Left-sided weakness
with altered sensorium
b) Without altered sensorium
2.
a)
Results
A total of 40 patients (18 males and 22 females) of stroke
who fulfilled the inclusion criteria were analysed. Out of
these, 26 were cases of ischaemic stroke while the other
14 cases were of haemorrhagic stroke. For valid
comparison, 40 age and sex matched controls were also
taken. Other than clinical parameters, serum hsCRP levels
were measured. In the present study, 45% patients were
males whereas 55% were females; mean age of the
stroke patients was 55.9 yrs in females and 63 yrs in
males. The most prevalent risk factor was diabetes,
followed by hypertension and dyslipidaemia. The most
common presenting symptom was altered sensorium
with left-sided weakness with facial palsy (Table I). 78.5%
of haemorrhagic stroke patients and 50% of ischaemic
stroke patients were having stage 2 hypertension on
admission. The different clinical and biochemical
parameters of ischaemic and haemorrhagic stroke cases
are compared in Table II. When mean hsCRP levels were
With aphasia
Ischaemic
(n = 14)
Haemorrhagic
(n = 26)
Age (yrs)
58.3
52.76
Sex (M/F)
12/14
6/8
Diabetes %
34.6%
57.1%
Hypertension %
23.0%
50%
Dyslipidaemia %
38.4%
28.5%
6.7 3.11
11.27 7.67
19
No. of patients
N = 80
Controls
40
1.6 0.5
Cases
40
8.02 5.08
July-September, 2010
205
Haemorrhagic
stroke
8.6 3.0
7.6 2.0
Survivors
3.02 1.9
6.93.8
Non-survivors
10.7 5.4
14.8 6.2
Discussion
Stroke is the third leading cause of mortality in the western
world and also a major cause of disability. Recently, it was
shown that elevated CRP levels independently predict the
risk of future stroke and transient ischaemic attack in the
elderly5. To analyse the role of hsCRP in stroke, the present
study was undertaken. It was conducted on 40 stroke
patients, among them, 26 were cases of ischaemic stroke
and the other 14 were cases of haemorrhagic stroke. A
control group having 40 persons, had been taken
randomly from healthy subjects who were similarly
evaluated as the stroke cases.
The age distribution of the patients in this study was
between 30 and 90 years. Mean age was 55.9 years in
females and 63 years in male. The risk of stroke increased
with increasing age as was found in the present study.
These findings were in corroboration with a study by
Bamford et al6. Besides old age, diabetes mellitus (42.5%)
was the most common risk factor found in various study
populations, followed by hypertension (32.5%) and
dyslipidaemia 35%). Kannel7 reported that diabetes
doubles the risk of stroke. Benson and Sacco8 observed
that hypertension confers a relative risk for stroke of 3- to
5-fold.
The most common presentation in the present study was
altered sensorium with left-sided hemiparesis with facial
palsy (45%).When the hsCRP levels were measured within
72 hours of admission, it was found to be high in cases of
stroke. Similar observations have been reported by various
other workers also. Di Napoli9 et al in their study included
128 patients. The CRP values within 24 hours and between
48 to 72 hours were 1.3 (0.5 to 3.3) and 1.0 (0.5 to 2.3) mg/
dl respectively. Arenillas10 et al, in their study showed that
a high-sensitivity CRP level above the receiver operating
characteristic curve cut-off value of 1.41 mg/dl emerged
206
July-September, 2010
8.
9.
References
1.
2.
3.
4.
5.
6.
July-September, 2010
207