High sensitivity C-Reactive Protein as a determinant in the Outcome of Acute Ischemic Stroke

Radha, D (2009) High sensitivity C-Reactive Protein as a determinant in the Outcome of Acute Ischemic Stroke. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: In recent years, there has been increasing evidence which shows strong links between inflammation and the pathogenesis of atherothrombotic stroke. Acute phase proteins have been implicated to play roles both during acute and chronic inflammatory processes in different diseases including ischemic stroke. Even low grade infections may cause elevation of various acute phase reactants which may partly be responsible for the inflammatory process observed in atherosclerotic lesions, which may inturn relate to occurrence of ischemic symptoms. Inflammation plays a major role in atherothrombosis and measurement of inflammatory markers such as C–Reactive Protein, an acute phase reactant that reflects low-grade systemic inflammation has been studied in a variety of cardiovascular diseases. There is growing evidence of the prognostic importance of CRP in ischemic stroke. Also CRP has been found to be a strong but relatively non-specific risk factor of fatal stroke in elderly persons. CRP, a sensitive meter of inflammation, induces vascular thrombosis by stimulating monocytes to express tissue factor, the initiator of the extrinsic pathway of coagulation. Elevated levels of CRP are found to be related with higher risk of first-ever cardiovascular, cerebrovascular and peripheral vascular diseases. The WHO has recently set international reference standard for the use of highly sensitive CRP assays. This has enhanced the usefulness of CRP as a reliable predictor of cardiovascular events. AIM: 1. To evaluate the predictive value of hs-CRP in relation to the ultimate functional outcome in first ever ischemic stroke after 4 weeks. 2. To correlate the hs-CRP levels with various cardiovascular risk factors. MATERIALS AND METHODS: Setting: Medical ward, Govt. Kilpauk Medical College, Chennai. Study design: Prospective hospital based study. Period of study: January 2008 to June 2008. Inclusion criteria: 1. All patients who presented within 48 hours of onset of stroke and who gave informed consent to participate in the study were included. Exclusion criteria: 1. Subarachnoid haemorrhage, subdural haemorrhage and intracerebral haemorrhage were excluded with the aid of CT scan. 2. Patients above 70 years of age were excluded. 3. Patients with evidence of active infection and neoplastic conditions at the time of study were excluded. 4. Patients with rheumatic heart disease and collagen vascular disease were excluded. 5. Patients who were actively smoking at the time of study were excluded. 6. Patients with previous history of transient ischemic attack or reversible ischemic neurological deficit were excluded. Study Method: A total of 50 patients who presented with acute ischemic stroke were enrolled into the study. That the stroke was an ischemic one was confirmed by CT scan. As soon as the patients were admitted within 48 hours of onset of stroke, serum samples were taken for hs-CRP estimation. Serum hs-CRP levels were also estimated in fifty normal patients (without any evidence of acute infection, neoplasm, rheumatic heart disease, collagen vascular disease, hypertension, DM, IHD) and was found to be within normal limits. Standard guidelines for the treatment of acute ischemic stroke were followed. None of the patients received any thrombolytic treatment. They were treated only with antiedema measures and antiplatelets such as aspirin alone and with good nursing care and physiotherapy. SUMMARY: This study was done to evaluate the predictive value of hs - CRP in relation to the ultimate functional outcome in first ever ischemic stroke after 4 weeks and also to correlate the hs - CRP levels with various cardiovasclar risk factors. It was found that patients with elevated hs - CRP levels had a poorer outcome when compared to patients lower levels of hs - CRP, 4 weeks after the onset of ischemic stroke. This study also showed that hs - CRP levels were elevated in patients with high B.P. Thus routine screening of susceptible populations like chronic smokers, alcoholics and first degree relatives of patients with IHD, stroke and DM may prove a valuable indicator for predicting future cardiovascular and neurovascular events. Thus hs - CRP measurements may be helpful in grading the patients into high risk and low risk category, for predicting future adverse atherothrombotic events and outcome. CONCLUSION: Patients with elevated hs-CRP had a poorer outcome when compared to patients with lower levels of CRP, four weeks after the onset of ischemic stroke. • hs-CRP levels showed statistically significant elevation in patients with high blood pressure. • hs-CRP levels had no significant correlation with age or gender. • hs-CRP did not show a statistically significant correlation with smoking or cholesterol intake. • There was no statistically significant correlation between hs-CRP levels and those with diabetes or IHD.

Item Type: Thesis (Masters)
Uncontrolled Keywords: High sensitivity C-Reactive Protein ; determinant ; Acute Ischemic Stroke.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 11 Mar 2018 04:57
Last Modified: 11 Mar 2018 04:57
URI: http://repository-tnmgrmu.ac.in/id/eprint/6132

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