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Blood C-reactive protein concentration with ABCD² is a better prognostic tool than ABCD² alone
Giovanni Corso1, Edo Bottacchi, Adriana Brusa
1Stroke Unit, Department of Neurology, Ospedale Regionale, Viale Ginevra n 3, Aosta, Italy. gcorso@ausl.vda.it
Insights
C-reactive protein (CRP) levels, along with the ABCD² score, independently predict ischaemic stroke in TIA patients. Routine CRP measurement can improve risk assessment for TIA patients, identifying those at higher risk.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Diagnostics
Background:
- Elevated C-reactive protein (CRP) is a known vascular event predictor in asymptomatic individuals and stroke patients.
- Limited research exists on CRP's prognostic value in transient ischaemic attack (TIA) patients.
- This study investigates CRP's role alongside traditional risk factors in predicting ischaemic stroke post-TIA.
Purpose of the Study:
- To assess C-reactive protein (CRP) levels as a prognostic indicator for ischaemic stroke in TIA patients.
- To compare the predictive efficacy of the ABCD² score alone versus combined with CRP levels.
- To determine if CRP measurement improves risk stratification in TIA patients.
Main Methods:
- Prospective, longitudinal evaluation of 194 TIA patients.
- Measurement of serum CRP levels and calculation of ABCD² scores.
- Utilized Cox proportional hazards models and receiver operating characteristic curve analysis (AUC) to assess predictive significance.
- Compared two models: ABCD² score alone (model 1) and ABCD² score plus CRP (model 2).
Main Results:
- Within two years, 33/194 TIA patients experienced ischaemic stroke.
- Both CRP levels (≥3 mg/l) and ABCD² scores (≥4) were identified as independent predictors of stroke.
- Model 2 (ABCD² + CRP) showed a statistically significant improvement in predictive ability (AUC 0.636) compared to model 1 (ABCD² alone, AUC 0.565; p=0.043).
- Integrated discrimination improvement analysis further supported CRP's added value in risk prediction.
Conclusions:
- Routine CRP measurement in the acute phase is a valuable tool for identifying TIA patients at elevated risk of ischaemic stroke.
- Incorporating CRP levels into risk assessment significantly enhances the predictive accuracy beyond the ABCD² score alone.
- This suggests CRP testing could refine clinical management strategies for TIA patients.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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