IJCRR - 5(2), January, 2013
Pages: 127-134
STUDY OF PROGNOSTIC SIGNIFICANCE OF SERUM C-REACTIVE PROTEIN AND ESR IN ACUTE ISCHEMIC STROKE
Author: Krishna Murthy H.A., Renuka Prasad Y.S.
Category: Healthcare
[Download PDF]
Abstract:
Background of the study: The stroke is defined as rapidly developing clinical signs of focal or global disturbance of cerebral function, lasting more than 24 hrs or leading to death, with no apparent cause other than vascular origin.1,2 An increasing body of evidence has linked inflammation with the pathogenesis of atherothrombotic stroke. The serum C-reactive protein (CRP) and ESR are acute-phase reactants, are indicators of underlying inflammation of endothelium and novel plasma markers for atherothrombotic disease.3,4,5
Aims and objectives: 1. To study the serum concentration of C-Reactive Protein [CRP] and ESR in patients of Acute ischemic stroke. 2. To compare it with that of age and sex matched controls. 3. One month follow up of the cases to know the results of stroke.
Methods: It is a case control study, in this 50 cases, who has CT brain confirmed, first attack of Acute ischemic stroke and 50 healthy controls were taken. For all patients CRP and ESR levels were measured, with in 72 hours of onset of stroke and followed up for one month to know the results of cases.
Results: The mean serum CRP level among the cases was 4.5±2.58mg/L and that among the controls it was 0.88±0.41 mg/L with the p value of < 0.001. There were 88% (44) of cases and 24% (12) of controls has CRP levels >0.8mg/L and 12%(6) of cases and 76%(38) of controls has CRP levels <0.8mg/L. The mean ESR value among the cases and controls in the present study was 32.33+11.80mm/hr and 19.80±6.80mm/hr respectively. After one month of follow up 12%(6) of cases with serum CRP value of 5.4mg/L and ESR of 38mm/hr were died, 26%(13) of patients with serum CRP value of 3.2mg/L and ESR of 25mm/hr were recovered from neurological features and 62%(31) of patients with serum CRP value of 4.9mg/L and ESR value of 34mm/hr were remained with same neurological features, which was statistically significant with the p value of <0.05, deaths were seen in highly raised CRP and ESR cases.
Conclusion:The serum CRP and ESR levels were higher in the cases compared to controls and the statistically significant results were also seen with the follow up of the cases.Hence it can be concluded that,inflammation is an important risk factor of endothelial damage and atherosclerosis.So measures to reduce the inflammation of endothelium and atherosclerotic plaque of blood vessels, in the long run can significantly reduce the incidence of stroke and its consequences in predisposed individuals.
Keywords: Acute ischemic stroke, CRP, ESR.
Citation:
Krishna Murthy H.A., Renuka Prasad Y.S.. STUDY OF PROGNOSTIC SIGNIFICANCE OF SERUM C-REACTIVE PROTEIN AND ESR IN ACUTE ISCHEMIC STROKE International Journal of Current Research and Review. 5(2), January, 127-134
References:
1. WHO, Technical Report Series 1976:469.
2. Aho K, Harmsen P, Hatano S, et al. Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ 1980; 58(1): 113-130
3. Natalia S .Roast, Philip A Wolf, Carlos S, Kase et al,’’Plasma concentration of Creactive protein and risk of ischemic stroke and trancient ischemic attack’’. The Framingham Study. Stroke Nov 2001;32;2575-2579
4. Guo Y, Jiang X, Zhou Z, Chen S, Zhao H, Li F ‘’Relationship between levels of serum creactive protein,leucocyte count and carotid plaque in patients with ischemic stroke’’ JHuazhong Univ Sci Technolog Med Sci . 2003;23[3];263-5.
5. Di Napoli M, Papa F, Bocola V. “Prognostic Influence of increased CRP and fibrinogen levels in ischemic stroke”. Stroke 2001;32:133-138;917-924
. 6. Tillet WS, Francis T, “Serological reactions in peneumonia with a non protein somatic fraction of pneumococcus”, J Exp Med., 1930;52;561-571.
7. Paul M Ridker, MD; Peter W.F. Wilson, MD; Scott M. Grundy, MD.”Should C-Reactive Protein be added to metabolic syndrome and to Assessment of Global Cardiovascular Risk?”. Criculation 2004;109:2818-2825
8. David F Keren, Jeffrey S. Warren. “Diagnostic immunology” 1992; 57-58.
9. Pepys MB, “The acute phase response and Creactive protein”, Chapter 11, 13.3 in Oxford Text book of Medicine, 3rd Edition, Weathurall DJ, Ledingham JGG, Warrell DA, Tokyo: Oxford University Press, 1906; 1527-1533.
10. Kushner I, Feld Man G, “Control of acute phase response Demonstration of C-reactive protein sysnthesis and secretion by hepatocytes during acute inflammation in the rabbit”, J. Exp Med, 1978, 148;466-77.
11. Merriman CR, Pulliam LA, Kampschmidt RF, “Effect of leukocytic endogenous mediator on C-reactive protein in rabbits” Proc Soc Exp Bio Med 1975;149;782-84.
12. Wade S. Smith, Stephen L. Hauser, Donald Easton. Cerebrovascular diseases. Harrison’s principles of internal medicine.16th edition. (Eds). Dennis L. Casper, Anthony L. Fauci, Dan L. Longo, Eugene Braunwald, Stephen L. Hauser. McGraw-Hill 2004.
13. Edward T.H. Yeh, MD. “CRP as a Mediator of Disease”. Circulation 2004; 109(Suppl II):II-11-II-14.
14. Sox HC, Liang MH: The erythrocyte sedimentation rate. Ann Intern Med 1986; 4:515-523
15. A.Chamorro, Md; N. vila, Md; Early prediction of stroke severity, role of the erythrocyte sedimentation rate. STROKE. 1995;26:573-576.
16. Shine B, De Beer FC, Pepys MB, “Solid phase radioimmuno assays for CReactive protein”, Clin CHem Acta 1981;117;13-23.
17. Oliveria EB, GOtschlich EC, Liu T, “Comparative studies on the binding properties of human and rabbit C-reactive protein”, J Immunol 1980;124;1396-402.
18. Tsujimoto M, Inoue K, Mojima S, “Creactive proteininduced agglutination of lipid suspensions prepared in the presence and absence of phosphatidlyl choline”, J. Biochem 1980;87;1531-37.
19. S C Mahapatra,PK Pillai,PK Hui,SK Tripathy, BK Behera,KK Samal “C-Reactive proteins in Thrombotic stroke” JAPI. Vol50;Dec2002
20. International Council for Standardization in Haematology (Expert Panel on Blood Rheology): ICSH recommendations for measurement of erythrocyte sedimentation rate. J Clin Pathol 1993; 46:198-208
21. Bernard Rosner (2000), Fundamentals of Biostatistics, 5th Edition, Duxbury.
22. M. Venkataswamy Reddy (2002), Statistics for Mental Health Care Research, NIMHANS publication, INDIA
23. J.David Curb, Robert D Abbott, Beatriz L Rodriguez et al ‘’CRP and the future risk of Thrombo embolic stroke in healthy men.’’Circulation April 2003,22,107[15].
24. Agarwal MP, Singh NR, Kaur IR. “CReactive Protein in acute cerebralinfarction”.JAPI. Vol51;Dec 2003
25. Dhamija RK, Gaba P, Jais M, Kumar M, Sherwal BL ‘’A Study of C-Reactive Protein levels in patients of Acute Ischemic Stroke and its correlation with lipids’’ JAPI.Vol51,Dec2003.
26. Muir KW, Weir CJ, Alwan W, Squire IB, Lees KR. C-reactive protein and outcome after ischemic stroke. Stroke. 1999;30(5):981–985.




List of abbreviations used; CRP-Creactiveprotein; ESR-Erythrocyte sedimentation rate.
|