Wang Luling, Wu Longfei, Lang Ye, Wu Di, Chen Jian, Zhao Wenbo, Li Chuanhui, Ji Xunming
Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Shengli Oilfield Central Hospital, Dongying, China.
Ann Transl Med. 2020 Nov;8(21):1379. doi: 10.21037/atm-20-3820.
Increasing evidence demonstrates that high-sensitivity C-reactive protein (hs-CRP) is an independent prognostic predictor in acute ischemic stroke (AIS) patients. The purpose of this study is to investigate the association between hs-CRP levels and clinical outcomes in AIS patients receiving endovascular therapy (EVT).
This observational study was based on a prospective registry study. AIS patients receiving EVT from December 2012 to January 2019 were included. The modified Rankin Scale (mRS) scores at the 90-day and long-term follow-up were evaluated as clinical outcomes. Multivariable logistic regression analysis was conducted to adjust for confounders. Receiver operating characteristic (ROC) curve analysis was performed based on significant predictors of favorable outcomes in the logistic regression analysis. Patients were divided into two groups according to the cutoff value. Clinical outcomes were compared between groups. Survival probability was assessed using Kaplan-Meier survival analysis.
Multivariable logistic regression analysis of the 362 enrolled AIS patients demonstrated that age (P=0.030), National Institutes of Health Stroke Scale (NIHSS) score (P=0.023), hs-CRP levels (P<0.001), and symptomatic intracranial hemorrhage (sICH) (P=0.006) were independently predictive of favorable outcomes. ROC curve analysis indicated that the hs-CRP level was predictive of favorable outcomes at the 90-day follow-up with a cutoff value of 8.255 mg/L. The mRS scores between patients with hs-CRP <8.255 mg/L and patients with hs-CRP ≥8.255 mg/L at the 90-day [2 (IQR, 1-2) 4 (IQR, 3-6), P<0.001] and long-term follow-up [1 (IQR, 0-2) 4 (IQR, 2-6), P<0.001] were significantly different. Patients with hs-CRP ≥8.255 mg/L had significantly increased risk of poor clinical outcomes at the 90-day and long-term follow-up compared with those with hs-CRP <8.255 mg/L (P<0.001 each).
Elevated hs-CRP levels were associated with poor clinical outcomes in AIS patients receiving EVT.
越来越多的证据表明，高敏C反应蛋白（hs-CRP）是急性缺血性卒中（AIS）患者独立的预后预测指标。本研究旨在探讨接受血管内治疗（EVT）的AIS患者hs-CRP水平与临床结局之间的关联。
本观察性研究基于一项前瞻性注册研究。纳入2012年12月至2019年1月接受EVT的AIS患者。将90天和长期随访时的改良Rankin量表（mRS）评分作为临床结局进行评估。进行多变量逻辑回归分析以校正混杂因素。基于逻辑回归分析中良好结局的显著预测因素进行受试者工作特征（ROC）曲线分析。根据临界值将患者分为两组。比较两组之间的临床结局。使用Kaplan-Meier生存分析评估生存概率。
对362例纳入的AIS患者进行多变量逻辑回归分析表明，年龄（P=0.030）、美国国立卫生研究院卒中量表（NIHSS）评分（P=0.023）、hs-CRP水平（P<0.001）和症状性颅内出血（sICH）（P= 0.006）是良好结局的独立预测因素。ROC曲线分析表明，hs-CRP水平在90天随访时对良好结局具有预测性，临界值为8.255 mg/L。hs-CRP<8.255 mg/L的患者与hs-CRP≥8.255 mg/L的患者在90天[2（四分位间距，1-2）对4（四分位间距，3-6），P<0.001]和长期随访[1（四分位间距，0-2）对4（四分位间距，2-6），P<0.001]时的mRS评分存在显著差异。与hs-CRP<8.255 mg/L的患者相比，hs-CRP≥8.255 mg/L的患者在90天和长期随访时临床结局不良的风险显著增加（各P<0.001）。
接受EVT的AIS患者hs-CRP水平升高与临床结局不良相关。
