Stroke Unit, Department of Neurology, Ospedale Regionale, Viale Ginevra n 3, Aosta, Italy.
Cerebrovasc Dis. 2011;32(2):97-105. doi: 10.1159/000328230. Epub 2011 Jun 28.
Increased C-reactive protein (CRP) is a known predictor of vascular events in asymptomatic individuals and stroke patients. Only a few studies included transient ischaemic attack (TIA) patients. We assessed CRP levels in addition to traditional risk factors in a cohort of patients with TIA to examine the relationship of these parameters to the occurrence of ischaemic stroke.
This is a prospective, longitudinal clinical evaluation of the efficacy of CRP as a prognostic indicator. CRP levels were measured in 194 TIA patients and in 1,024 asymptomatic individuals (recruited from a project on stroke prevention, the PrATO, which was ongoing at the same time in the Aosta Valley). A clinical risk score was determined using the ABCD² score in TIA patients. The area under the receiver operating characteristic curve (AUC) was used to evaluate the significance of the markers as predictors. Two models were evaluated: model 1 used the ABCD² score and model 2 used serum CRP levels in addition to the ABCD²) score. The primary outcome was an ischaemic stroke.
Within 2 years ischaemic strokes occurred in 33/194 patients. The Cox proportional hazards models, after adjustments for conventional risk factors, identified CRP levels ≥3 mg/l and ABCD² scores ≥4 as independent predictors of stroke. The corresponding AUCs were 0.565 and 0.636, based on model 1 and model 2, respectively; this represented a statistically significant difference (p = 0.043). The absolute integrated discrimination improvement was 0.0249 (p = 0.007) and the relative integrated discrimination improvement was 2.3710. The net benefit became significant from a predicted probability ≥10% and was 0.077 when based on model 1 and 0.087 when based on model 2.
Routine CRP measurements in the acute phase might be a useful tool for identifying TIA patients who are at a higher risk of ischaemic stroke. The additional use of CRP levels for the risk assessment in TIA patients improves risk definition in terms of the ABCD² score alone.
已知 C 反应蛋白（CRP）升高是无症状个体和中风患者发生血管事件的一个预测指标。只有少数研究纳入了短暂性脑缺血发作（TIA）患者。我们评估了 TIA 患者除传统危险因素以外的 CRP 水平，以研究这些参数与缺血性中风发生的关系。
这是一项 CRP 作为预后指标的前瞻性、纵向临床评估研究。在 194 例 TIA 患者和 1024 例无症状个体（从同一时间在奥斯塔山谷进行的中风预防项目“PrATO”中招募）中测量 CRP 水平。TIA 患者采用 ABCD²评分确定临床风险评分。采用受试者工作特征曲线下面积（AUC）评估标志物作为预测指标的意义。评估了两种模型：模型 1 使用 ABCD²评分，模型 2 除了 ABCD²评分外，还使用血清 CRP 水平。主要结局是缺血性中风。
在 2 年内，194 例患者中有 33 例发生缺血性中风。在调整了传统危险因素后，Cox 比例风险模型发现 CRP 水平≥3mg/L 和 ABCD²评分≥4 是中风的独立预测因子。基于模型 1 和模型 2，相应的 AUC 分别为 0.565 和 0.636，这代表了统计学上的显著差异（p=0.043）。绝对综合鉴别改善为 0.0249（p=0.007），相对综合鉴别改善为 2.3710。当基于模型 1 时，预测概率≥10%时净收益具有统计学意义，为 0.077；当基于模型 2 时，为 0.087。
在急性期常规 CRP 测量可能是识别中风风险较高的 TIA 患者的有用工具。在 TIA 患者的风险评估中额外使用 CRP 水平可提高 ABCD²评分单独评估的风险定义。
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