Prognostic Significance of Highly Sensitive C-Reactive Protein in Acute Ischemic Stroke Patients

Rajkumar, J (2013) Prognostic Significance of Highly Sensitive C-Reactive Protein in Acute Ischemic Stroke Patients. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Stroke is now considered as an important health problem for all individuals and society. After Acute myocardial infarction and malignancy, Ischemic stroke is the third leading cause of death and is also as leading cause of hospitalization causing disability. So we have to identify the stroke at an earlier date which help the treating physicians to plan treatment, make interventions and to provide significant benefit to the people and community and to save the patient. The conventional risk factors namely blood pressure (BP), smoking, diabetes, dyslipidemia, alcohol predict the happening of stroke, but still they are not completely reliable, therefore there is a continuous debate and search for prediction of occurrence of stroke and reliability of prognostic markers in stroke have gained interest in recent years. When an individual is exposed to any insult in terms of infection and injury, there is a production of proteins called Acute Phase Proteins. This Acute phase protein participates in all inflammatory process and plays a major role in both acute and chronic inflammatory states. The Acute phase reactants are fibrinogen, ferritin, haptoglobin, highly sensitive C – reactive protein, Complements (C3), Complements (C4), Tumour necrosis factor. Among these various proteins, Highly sensitive C-reactive protein have gained wide recognition in monitoring different diseased states and it leads to the development of reliable and fast assay measuring their plasma levels. In recent years, inflammatory process plays an important role in pathophysiology of stroke. The initiator of extrinsic pathway of coagulation is Tissue factor. This tissue factor got expressed when mainly monocytes are stimulated by C-reactive protein and initiates vascular thrombosis. hsCRP, a marker of Atherosclerosis and also a peripheral marker of inflammation found to be valuable in sorting out of possible risk factors of subsequent cerebrovascular and cardiovascular (CV) events, Peripheral Arterial Diseases or death. This important fact was also supported by abundant laboratory and experimental evidence demonstrating that atherosclerosis refers to chronic inflammatory process. High plasma levels of CRP are not specific to disease, but it is sensitive marker and is produced in response to tissue injury, infectious agents and inflammation. hsCRP predicts the first cardiovascular event in general populations. hsCRP is the only inflammatory marker which independently predicts the future risk of stroke when measured prior to onset of clinical disease. AIMS & OBJECTIVES: 1) To evaluate the prognostic significance of hsCRP with severity of stroke in correlation with stroke scales (NIHSS and MRS). 2) To evaluate the relationship between hsCRP and various risk factors for stroke, with territory of infarct and other findings in CT film. MATERIALS AND METHODS: Setting: Patients admitted in medical ward, Government Rajaji Hospital, Madurai. Colaborative Departments: Department of Biochemistry, Neurology, Radiology, Medicine, Madurai Medical College, Madurai. Study Design: Prospective cross sectional observation study. Period of Study: March 2012 to October 2012. Study Population: 50 Acute ischemic stroke patients admitted in medical ward, Government Rajaji Hospital, Madurai. Inclusion Criteria: 1. All patients with new onset focal neurological deficit following ischemic stroke, presented within 48 hours of onset of stroke are taken into study. 2. Patients >14 years and of both sexes are included in the study. 3. Patients with new onset stroke with past history of hypertension, diabetes mellitus, dyslipidemeia, smoking, alcohol were included. Exclusion Criteria: 1. Patients with age more than 80 years were excluded. 2. Patients with malignancy and clinical findings and blood investigations suggestive of infection were excluded. 3. Individuals with Connective Tissue disorders and Rheumatic heart disease, Coronary Artery disease were excluded. 4. Patients with prior history of transient ischemic attacks or reversible ischemic neurological deficit, cerebrovascular accidents were excluded. 5. Patients with features of haemorrhage such as sub-dural haemorrhage, sub-arachnoid haemorrhage, and intracerebral haemorrhage were excluded with the aid of CT scan. 6. History of recent surgery and trauma. 7. CNS tumors. STUDY METHODS: 50 patients who had acute ischemic stroke were taken for study. Those patients who got admitted within 48 hours of onset of stroke were only included in this study. As soon as patient got admitted, verbal consent was obtained from patient or attenders. Then complete and relevant medical history, complete neurological examination, routine blood and radiological investigations were done and all data were recorded in a standardized proforma. RESULTS: Totally 50 cases were included in the study. Among the 50 cases included in this study 28 cases (56%) had hsCRP values ≥ 3 mg/l and 22 cases (44%) had hsCRP < 3 mg/l. Number of patients died in this group is 6. All these patients had a hsCRP of ≥ 3 mg/l. Out of these 28 cases who has hsCRP ≥ 3 mg/l, 26.67% of cases comes under moderately severe category and 73.33% cases comes under severe category. On the other hand, among the remaining 22 cases who had hsCRP <3mg/l, all the 22 cases comes under moderately severe and none in severe group. Pearson's r correlation also reveals the strong correlation between hsCRP and NIHSS scores. Pearson's r value is 0.844 which is close to one. A positive correlation exists between these 2 variables with a "p" value of 0.00, which is statistically significant. Scatter plot analysis reveals the positive correlation between hsCRP & NIHSS. Any increase or decrease in hsCRP score analogous linearly with increase/decrease severity score of NIHSS. Out of 28 cases with hsCRP ≥3 mg/l 4 cases were in good outcome category and 24 cases in poor outcome category of MRS scores. In contrast among 22 cases with hsCRP < 3 mg/l, 16 cases were in good outcome and 6 cases were in poor outcome category in MRS Score. Pearson‟s r correlation analysis reveals strong as well as positive correlation between hsCRP and MRS. Pearson‟s r value is 0.900 which is close to 1 and is positive variable. So any increase in hsCRP will favour the poor outcome of patients in terms of death and severe disability. CONCLUSION: This present study is a cross sectional observation study of prognostic significance of highly sensitive C-reactive protein in acute ischemic stroke patients. • The present study shows male predominance with majority of patients in the age group of greater than 50 years. • The present study revealed significant association between hsCRP and Diabetes Mellitus, Hypertension & Cholesterol level. • This study demonstrates the significant rise in hsCRP in ischemic stroke patients in correlation with high scores with NIHSS which indicates the severity. • This study reveals the poor outcome in correlation with high hsCRP values and good outcome in correlation with low hsCRP values. • This study also explains statistically significant relationship between hsCRP and infarct. • There is no statistically significant relationship between hsCRP and age, sex, smoking and alcohol.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Prognostic significance ; Highly Sensitive C-Reactive Protein ; Acute Ischemic Stroke Patients.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 20 Mar 2018 03:26
Last Modified: 20 Mar 2018 16:23

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