A study of C-reactive protein in acute ischemic stroke

 

R Panneer Selvam¹, V Premnath^2*

 

¹Assistant Professor, ²Sr. Resident, Department of General Medicine, Vinayaka Missions Medical College and Hospitals- Karaikal, Puducherry, INDIA.

Email: aravindhkrishnan94@gmail.com

 

Abstract              Background and Objective: Cerebrovascular accident, which has considerable mortality and morbidity, deserves attention towards its prevention. the line of defence in stroke prevention are detecting and adequately treating manageable risk factors. C-reactive protein, an acute phase reactant is an indicator of underlying systemic inflammation and a novel marker is an indicator of underlying systemic inflammation and anovel marker for atherothrombotic disease. present study is an attempt to study the levels of c-reactive protein in acute ischemic stoke Methods: It is a cross sectional study of 50 patients with diagnosis of first ever ischemic stroke (<72 hrs) in Vinayaka mission medical college, karaikal. Patients were examined and investigated as per proforma. Results: In our study 29(58%) patients who had CRP>0.6mg/dl. The mean CRP was 0.7164mg/dl which is statistically significant. Interpretation and Conclusion: C-reactive protein appears to be an important risk factor for acute ischemic stroke at levels >0.6mg/dl

 

INTRODUCTION

Stroke is the rapid development of a focal neurological deficit caused by a disruption of blood supply to the corresponding area of brain. Stroke is also a leading cause of functional impairments, With 20% of survivors requiring institutional care after 3 months and 15% to 30% being permanently disabled. Inflammation is important in ischemic stroke, both in the development of atherosclerosis and during the ischemic event. Elevated levels of C-Reactive protein (CRP) are present among patients at risk for further first ever stroke.

 

MATERIAL AND METHODS

It is a cross sectional study of 50 patients conducted in Vinayaka mission medical college, karaikal.

Inclusion Criteria: All the patients of first ever CT proven ischemic stroke admitted within 72 hours of symptom onset.

Exclusion Criteria: Patients with following conditions, identified by history, clinical examination and investigations are excluded form the study

• Valvular heart disease
• Women on oral contraceptives
• Ischemic heart disease
• Atrial fibrillation
• Acute infectious disease
• Osteoarthritis, costochondritis, rheumatoid arthritis, ankylosing spondylosis and other disorders
• Known or suspected neoplastic disorders
• Recent (less than 3 months) major trauma, burns, surgery.
• Patients with ischemic stroke after 72 hours of symptom onset

Statistical Analysis: Data was statistically analysed

RESULT

In our study 29 (58%) patients who had CRP>0.6 mg/dl. The mean CRP was 0.7164mg/dl which is statistically significant.

 

Table 1: Showing C-reactive protein distribution among both the sexes

 

Table 2: Correlation between CRP and diabetes mellitus

 

Table 3: Correlation between CRP and systemic hypertension

 

Table 4: Showing correlation between CRP and smoking

 

Table 5: Showing correlation of LDL with CRP

 

Table 6: Showing correlation of serum cholesterol with CRP

 

Table 7: Showing correlation of triglycerides with CRP

 

Table 8: Correlation of CRP with mean serum HDL

 

• In our study 17 (34)% patients were diabetic and 33 (66)% were non-diabetic. Among 29 patients with CRP>0.6mg/dl, 11(3.93%) were diabetic, 18 (62.06%) were non-diabetic. Among 21 patients with CRP<0.6mg/dl, 6 (28.57%) were diabetic and 15(74.42%)  were non –diabetic
• In our study 34 (68%) patients were hypertensive and 16 (32%) were normotensive. Among the 29 patients with CRP>0.6mg/dl, 19 (65.51%) were hypertensive and 10 (34.48%) were normotensive. Among 221 patients who had CRP<0.6mg/dl, 15 (71.42%) were hypertensive and 6 (28.57%) were normotensive
• In our study 14 (28%) were smokers and 36(72%) are non smokers. Among the 29 patients with CRP>0.6mg/dl, 9(31%) were smokers and 20 (68.9%) were non smokers. Among 21 patients with CRP<0.6mg/dl, 5(23.80%) were smokers and 16(76.19%) were non smokers.
• In our study the mean of LDL was higher (107.28) in patients who had CRP>0.6mg/dl than those with CRP<0.6mg/dl (100.59)
• In our study the mean serum cholesterol was higher in patients with CRP>0.6mg/dl(182.57) than those with CRP<0.6mg/dl (177.30)
• In our study the mean serum triglycerides level was lower (137.18) in patients with CRP>0.6mg/dl than in patients with CRP<0.6mg/dl(160mg/dl)
• In our study the mean HDL in patients with CRP>0.6mg/dl was higher(47.25) than patients with CRP<0.6mg/dl(46.5)

 

DISCUSSION

The present study is a hospital based, cross sectional study with 50 patients.

• Among the 50 patients, 31(62%) were males and 19(38%) were females
• The mean age of patients was 60 years
• The most common mode of presentation of CVA in our study was hemiplegia/paresis that occurred in 48(96%) of patients, followed by cranial nerve involvement in 47(94%), aphasia in 25(50%), seizures in 3(6%), altered sensorium in 2(4%) and headache in 1(2%)
• Cases constituting 12% had history of TIA in the past, among which 8% were males and 4% were females
• The most common risk factor in our study was systemic hypertension 34(68%), followed by diabetes mellitus in 17(34%) and smoking in 14(28%).

 

CONCLUSION

CRP appears to be an important risk factor for acute ischemic stroke at levels of >0.6mg/dl.

 

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