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Interleukin-6, C-reactive protein, fibrinogen, and risk of recurrence after ischaemic stroke: Systematic review and

J J McCabe1,2,3,4, E O'Reilly1, S Coveney1,2,5

  • 1Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.

European Stroke Journal
|April 5, 2021
PubMed

Insights

Inflammatory markers like C-reactive protein and fibrinogen are linked to recurrent stroke and major vascular events. Further research is needed to clarify their prognostic role and guide anti-inflammatory therapies.

Area of Science:

  • Cardiovascular Medicine
  • Neuroscience
  • Biomarkers

Background:

  • Anti-inflammatory therapies show promise in coronary disease but are understudied in stroke.
  • The prognostic value of inflammatory markers post-stroke is unclear, and current guidelines do not recommend their routine use for risk stratification.

Purpose of the Study:

  • To systematically review and meta-analyze the association between key inflammatory markers and the risk of recurrent stroke or major vascular events (MVEs).
  • To evaluate the prognostic significance of C-reactive protein (CRP), interleukin-6 (IL-6), and fibrinogen in stroke survivors.

Main Methods:

  • A systematic review of EMBASE and Ovid Medline databases was conducted up to October 1, 2019.
  • Random-effects meta-analysis was performed on studies reporting comparable effect measures for CRP, IL-6, and fibrinogen.
  • Included studies investigated the association between these markers and recurrent stroke or MVEs.

Main Results:

  • Of 2,515 identified reports, 39 met eligibility criteria.
  • C-reactive protein (CRP) was significantly associated with an increased risk of recurrent stroke (HR 1.14 per SD increase) and MVEs (HR 1.21 per SD increase).
  • Fibrinogen also showed a significant association with recurrent stroke (HR 1.26) and MVEs (HR 1.31). Trends for IL-6 were observed but did not reach statistical significance.

Conclusions:

  • Evidence suggests an association between inflammatory markers and post-stroke vascular recurrence, but significant methodological heterogeneity exists.
  • Individual-patient data pooling and standardized methods are crucial to definitively establish the prognostic role of these markers.
  • Improved understanding may aid patient selection for future anti-inflammatory therapy trials in stroke.
Abstract

Keywords:
C-reactive proteinIschaemic strokefibrinogeninflammationinterleukin-6prognosisrecurrencetransient ischaemic attack

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