Please wait a minute...
Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med Chin    2009, Vol. 3 Issue (1) : 30-35    https://doi.org/10.1007/s11684-009-0005-x
RESEARCH ARTCILE
Elevated C-reactive protein levels predict worsening prognosis in Chinese patients with first-onset stroke
Jiangtao YAN1, Rutai HUI2, Daowen WANG1()
1. The Institute of Hypertension and Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China; 2. Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China
 Download: PDF(123 KB)   HTML
 Export: BibTeX | EndNote | Reference Manager | ProCite | RefWorks
Abstract

The role of high sensitivity C-reactive protein (hsCRP) in predicting prognosis after stroke in the Asian population has not been investigated. We hypothesized that elevated levels of hsCRP were associated with worsening prognosis after stroke in Chinese patients. Two hundred and ninety consecutive patients with first-onset stroke and 290 age- and gender-matched control subjects without any cerebrovascular disease were enrolled for study. Plasma hsCRP level was detected and subsequent vascular events and death were recorded in both groups over a 5-year period. Compared to control group, patients presenting with stroke had higher plasma hsCRP level (3.3 ± 3.8 vs 1.3 ± 2.2 mg/L, P< 0.01). Furthermore, in the group of patients with stroke, the mean plasma hsCRP level was higher in patients who developed subsequent vascular diseases or died as compared with the patients without further complications (4.4 ± 4.3 vs 2.7 ± 3.3 mg/L, P< 0.01). Compared to the lowest tertile of hsCRP level, the relative risk for vascular events or death in stroke patients was 2.91 in the highest tertile of hsCRP (95% CI, 1.54–5.50, P = 0.001). This increase in relative risk for vascular events or death in stroke patients continued after adjustment for age, sex and other cardiovascular risk factors such as hypertension and diabetes (OR: 2.771, 95% CI: 1.367–5.617, P = 0.005). These findings indicate that increased hsCRP level is associated with worsening prognosis after stroke in Chinese patients and suggests that inflammation is correlated with stroke outcome.

Keywords C-reactive protein      inflammation      stroke     
Corresponding Author(s): WANG Daowen,Email:dwwang@tjh.tjmu.edu.cn   
Issue Date: 05 March 2009
 Cite this article:   
Jiangtao YAN,Rutai HUI,Daowen WANG. Elevated C-reactive protein levels predict worsening prognosis in Chinese patients with first-onset stroke[J]. Front Med Chin, 2009, 3(1): 30-35.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-009-0005-x
https://academic.hep.com.cn/fmd/EN/Y2009/V3/I1/30
stroke groupcontrol groupP value
age/yr63 ± 963 ± 8&gt; 0.05
sex (female), n (%) 106 (36.6)106 (36.6)&gt; 0.05
body mass index/kg·m–224.1 ± 4.323.7 ± 3.2&gt; 0.05
hypertension, n (%)185 (63.8)120 (41.4)&lt; 0.01
SBP/mmHg147 ± 24137 ± 21&lt; 0.01
DBP/mmHg89 ± 1482 ± 12&lt; 0.01
diabetes, n (%)34 (11.7)14 (4.8)&lt; 0.01
hyperlipidemia, n (%)65 (22.4)81 (27.9)&gt; 0.05
current smoking, n (%)54 (18.6)53 (18.3)&gt; 0.05
plasma CRP/mg·L–13.3 ± 3.81.3 ± 2.2&lt; 0.01
Tab.1  Baseline characteristics of the participants
Fig.1  Comparison of hsCRP levels in patients with different stroke types. *: < 0.01 compared to control, **: < 0.01 compared to control or cerebral thrombosis or lacunar infarction
Fig.2  Probability of primary endpoint in patients with stroke relative to different tertiles of hsCRP during 5-year follow-up
hsCRP tertilerelative risk95% CIP value
&lt; 11
1–3.41.5730.823–3.0080.17
&gt; 3.42.9131.544–5.4950.001
Tab.2  Relative risk of primary endpoint and tertiles of hsCRP levels
hsCRP tertileodds ratio95% CIP value
&lt; 11
1–3.41.5490.767–3.1280.222
&gt; 3.42.7711.367–5.6170.005
Tab.3  Adjusted odds ratio of primary endpoint and hsCRP
Fig.3  Adjusted odds ratio for endpoint events relative to hsCRP tertile. *: = 0.005, compared to the lowest tertile of hsCRP.
Fig.4  Probability of primary endpoint in the control group relative to different tertiles of hsCRP
1 Libby P. Inflammation in atherosclerosis. Nature , 2002, 420(6917): 868-874
doi: 10.1038/nature01323
2 Blake G J, Ridker P M. Inflammatory bio-markers and cardiovascular risk prediction. J Intern Med , 2002, 252(2): 283-294
doi: 10.1046/j.1365-2796.2002.01019.x
3 Engstrom G, Hedblad B, Stavenow L, Tyden P, Lind P, Janzon L, Lindgarde F. Fatality of future coronary events is related to inflammation-sensitive plasma proteins: A population-based prospective cohort study. Circulation , 2004, 110(1): 27-31
doi: 10.1161/01.CIR.0000133277.88655.00
4 Ridker P M, Hennekens C H, Buring J E, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med , 2000, 342(12): 836-843
doi: 10.1056/NEJM200003233421202
5 Danesh J, Wheeler J G, Hirschfield G M, Eda S, Eiriksdottir G, Rumley A, Lowe G D O, Pepys M B, Gudnason V. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med , 2004, 350(14): 1387-1397
doi: 10.1056/NEJMoa032804
6 Koenig W, Sund M, Frohlich M, Fischer H G, Lowel H, Doring A, Hutchinson W L, Pepys M B. C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: Results from the monica (monitoring trends and determinants in cardiovascular disease) augsburg cohort study, 1984 to 1992. Circulation , 1999, 99(2): 237-242
7 Ridker P M, Cushman M, Stampfer M J, Tracy R P, Hennekens C H. Plasma concentration of c-reactive protein and risk of developing peripheral vascular disease. Circulation , 1998, 97(5): 425-428
8 Rost N S, Wolf P A, Kase C S, Kelly-Hayes M, Silbershatz H, Massaro J M, D'Agostino R B, Franzblau C, Wilson P W. Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study. Stroke , 2001, 32(11): 2575-2579
doi: 10.1161/hs1101.098151
9 Thompson S G, Kienast J, Pyke S D, Haverkate F, van de Loo J C. Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. N Engl J Med , 1995, 332(10): 635-641
doi: 10.1056/NEJM199503093321003
10 Haverkate F T S, Pyke S D, Gallimore J R, Pepys M B. Production of c-reactive protein and risk of coronary events in stable and unstable angina. European concerted action on thrombosis and disabilities angina pectoris study group. Lancet , 1997, 349(9050): 462-466
doi: 10.1016/S0140-6736(96)07591-5
11 Liuzzo G, Biasucci L M, Gallimore J R, Grillo R L, Rebuzzi A G, Pepys M B, Maseri A. The prognostic value of c-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med , 1994, 331(7): 417-424
doi: 10.1056/NEJM199408183310701
12 Hansson G K. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med , 2005, 352(16): 1685-1695
doi: 10.1056/NEJMra043430
13 Ridker P M, Cushman M, Stampfer M J, Tracy R P, Hennekens C H. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med , 1997, 336(14): 973-979
doi: 10.1056/NEJM199704033361401
14 Mega J L, Morrow D A, Cannon C P, Murphy S, Cairns R, Ridker P M, Braunwald E. Cholesterol, c-reactive protein, and cerebrovascular events following intensive and moderate statin therapy. J Thromb Thrombolysis . 2006, 22(1): 71-76
doi: 10.1007/s11239-006-8081-0
15 Ridker P M, Cannon C P, Morrow D, Rifai N, Rose L M, McCabe C H, Pfeffer M A, Braunwald E. the Pravastatin or Atorvastatin Evaluation and Infection Therapy Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) Investigators. C-reactive protein levels and outcomes after statin therapy. N Engl J Med , 2005, 352(1): 20-28
doi: 10.1056/NEJMoa042378
16 Di Napoli M, Papa F, Bocola V. C-reactive protein in ischemic stroke: An independent prognostic factor. Stroke , 2001, 32(4): 917-924
17 Muir K W, Weir C J, Alwan W, Squire I B, Lees K R. C-reactive protein and outcome after ischemic stroke. Stroke , 1999, 30(5): 981-985
18 Elkind M S, Tai W, Coates K, Paik M C, Sacco R L. High-sensitivity c-reactive protein, lipoprotein-associated phospholipase a2, and outcome after ischemic stroke. Arch Intern Med , 2006, 166(19): 2073-2080
doi: 10.1001/archinte.166.19.2073
19 Torzewski J T M, Bowyer D E, Frohlich M, Koenig W, Waltenberger J, Fitzsimmons C, Hombach V. C-reactive protein frequently colocalizes with the terminal complement complex in the intima of early atherosclerotic lesions of human coronary arteries. Arterioscler Thromb Vasc Biol , 1998, 18(9): 1386-1392
20 Zhang Y X, Cliff W J, Schoefl G I, Higgins G. Coronary c-reactive protein distribution: Its relation to development of atherosclerosis. Atherosclerosis , 1999, 145(2): 375-379
doi: 10.1016/S0021-9150(99)00105-7
21 Chang M K, Binder C J, Torzewski M, Witztum J L. From the cover: C-reactive protein binds to both oxidized ldl and apoptotic cells through recognition of a common ligand: Phosphorylcholine of oxidized phospholipids. PNAS , 2002, 99(20): 13043-13048
doi: 10.1073/pnas.192399699
22 Pasceri V, Willerson J T, Yeh E T. Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation , 2000, 102(18): 2165-2168
23 Devaraj S, Xu D Y, Jialal I. C-reactive protein increases plasminogen activator inhibitor-1 expression and activity in human aortic endothelial cells: Implications for the metabolic syndrome and atherothrombosis. Circulation , 2003, 107(3): 398-404
doi: 10.1161/01.CIR.0000052617.91920.FD
24 Zwaka T P, Hombach V, Torzewski J. C-reactive protein-mediated low density lipoprotein uptake by macrophages: Implications for atherosclerosis. Circulation , 2001, 103(9): 1194-1197
25 Venugopal S K, Devaraj S, Yuhanna I, Shaul P, Jialal I. Demonstration that c-reactive protein decreases enos expression and bioactivity in human aortic endothelial cells. Circulation , 2002, 106(12): 1439-1441
doi: 10.1161/01.CIR.0000033116.22237.F9
26 Aronowski J, Hall C E. New horizons for primary intracerebral hemorrhage treatment: Experience from preclinical studies. Neurol Res , 2005, 27(3): 268-279
doi: 10.1179/016164105X25225
27 Xue M, Del Bigio M R. Immune pre-activation exacerbates hemorrhagic brain injury in immature mouse brain. J Neuroimmunol , 2005, 165(1-2): 75-82
doi: 10.1016/j.jneuroim.2005.04.016
28 Zhang X F, Attia J, D'Este C, Yu X H. Prevalence and magnitude of classical risk factors for stroke in a cohort of 5092 Chinese steelworkers over 13.5 years of follow-up. Stroke , 2004, 35(5): 1052-1056
doi: 10.1161/01.STR.0000125305.12859.ff
29 Leppala J M, Virtamo J, Fogelholm R, Albanes D, Heinonen O P. Different risk factors for different stroke subtypes: Association of blood pressure, cholesterol, and antioxidants. Stroke , 1999, 30(12): 2535-2540
30 Manabe S, Okura T, Watanabe S, Higaki J. Association between carotid haemodynamics and inflammation in patients with essential hypertension. J Hum Hypertens , 2005, 19(10): 787-791
doi: 10.1038/sj.jhh.1001898
31 Garanty-Bogacka B, Syrenicz M, Syrenicz A, Gebala A, Lulka D, Walczak M. Serum markers of inflammation and endothelial activation in children with obesity-related hypertension. Neuro Endocrinol Lett , 2005, 26(3): 242-246
[1] Jian Liu, Pingyan Shen, Xiaobo Ma, Xialian Yu, Liyan Ni, Xu Hao, Weiming Wang, Nan Chen. White blood cell count and the incidence of hyperuricemia: insights from a community-based study[J]. Front. Med., 2019, 13(6): 741-746.
[2] Nikolay V. Tsygan, Alexandr P. Trashkov, Igor V. Litvinenko, Viktoriya A. Yakovleva, Alexandr V. Ryabtsev, Andrey G. Vasiliev, Leonid P. Churilov. Autoimmunity in acute ischemic stroke and the role of blood--brain barrier: the dark side or the light one?[J]. Front. Med., 2019, 13(4): 420-426.
[3] Ning Jiang, Yao Li, Ting Shu, Jing Wang. Cytokines and inflammation in adipogenesis: an updated review[J]. Front. Med., 2019, 13(3): 314-329.
[4] Xiaohan Yang, Tiezheng Zheng, Hao Hong, Nan Cai, Xiaofeng Zhou, Changkai Sun, Liying Wu, Shuhong Liu, Yongqi Zhao, Lingling Zhu, Ming Fan, Xuezhong Zhou, Fengxie Jin. Neuroprotective effects of Ginkgo biloba extract and Ginkgolide B against oxygen–glucose deprivation/reoxygenation and glucose injury in a new in vitro multicellular network model[J]. Front. Med., 2018, 12(3): 307-318.
[5] Yufeng Zhao, Bo Liu, Liyun He, Wenjing Bai, Xueyun Yu, Xinyu Cao, Lin Luo, Peijing Rong, Yuxue Zhao, Guozheng Li, Baoyan Liu. A novel classification method for aid decision of traditional Chinese patent medicines for stroke treatment[J]. Front. Med., 2017, 11(3): 432-439.
[6] Zhen Zhang, Na Jiang, Zhaohui Ni. Strategies for preventing peritoneal fibrosis in peritoneal dialysis patients: new insights based on peritoneal inflammation and angiogenesis[J]. Front. Med., 2017, 11(3): 349-358.
[7] Marijke A. de Vries,Arash Alipour,Erwin Birnie,Andrew Westzaan,Selvetta van Santen,Ellen van der Zwan,Anho H. Liem,Noëlle van der Meulen,Manuel Castro Cabezas. Coronary leukocyte activation in relation to progression of coronary artery disease[J]. Front. Med., 2016, 10(1): 85-90.
[8] Jianping Ye. Beneficial metabolic activities of inflammatory cytokine interleukin 15 in obesity and type 2 diabetes[J]. Front. Med., 2015, 9(2): 139-145.
[9] Yingchen Li,Guoheng Hu,Qilai Cheng. Implantation of human umbilical cord mesenchymal stem cells for ischemic stroke: perspectives and challenges[J]. Front. Med., 2015, 9(1): 20-29.
[10] Zhicheng Zhang,Jun Yang,Mingchao Li,Wei Cai,Qingquan Liu,Tao Wang,Xiaolin Guo,Shaogang Wang,Jihong Liu,Zhangqun Ye. Paratesticular fibrous pseudotumor: a report of five cases and literature review[J]. Front. Med., 2014, 8(4): 484-488.
[11] Khurram Siddique, Shirin Mirza, Gandra Harinath. Appendiceal inflammation affects the length of stay following appendicectomy amongst children: a myth or reality?[J]. Front Med, 2013, 7(2): 264-269.
[12] Jianping Ye. Mechanisms of insulin resistance in obesity[J]. Front Med, 2013, 7(1): 14-24.
[13] Tao Li, Nanfu Luo, Lei Du, Jin Liu, Lina Gong, Jing Zhou. Early and marked up-regulation of TNF-α in acute respiratory distress syndrome after cardiopulmonary bypass[J]. Front Med, 2012, 6(3): 296-301.
[14] Marie-Germaine Bousser. Stroke prevention: an update[J]. Front Med, 2012, 6(1): 22-34.
[15] Min-Hao WU, Ping ZHANG, Xi HUANG, . Toll-like receptors in innate immunity and infectious diseases[J]. Front. Med., 2010, 4(4): 385-393.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed