Serum C-reactive protein adds predictive information for post-stroke delirium: The PROPOLIS study

Area of Science:

• Neurology
• Biomarkers
• Clinical Prediction Models

Background:

• Delirium is a frequent and severe complication following stroke.
• Accurate prediction of post-stroke delirium is crucial for timely intervention and patient management.
• Current prediction models rely on clinical factors, but their accuracy can be limited.

Purpose of the Study:

• To evaluate if incorporating C-reactive protein (CRP) levels enhances the accuracy of delirium prediction in acute stroke patients.
• To assess the improvement in predictive metrics when CRP is added to existing clinical models.
• To determine the utility of CRP as a biomarker for stratifying delirium risk post-stroke.

Main Methods:

• Analysis of data from 459 patients in the Prospective Observational Polish Study on post-stroke delirium.
• Inclusion of patients with acute stroke or TIA and available serum CRP levels on admission.
• Assessment of delirium occurrence within 7 days of hospitalization and evaluation of CRP's impact on two clinical prediction models (Model A and Model B).

Main Results:

• Delirium was diagnosed in 29.2% of patients, with higher CRP levels observed in those who developed delirium (median 13.2 vs. 4.4 mg/L).
• Elevated CRP (>7.09 mg/L) was significantly associated with an increased risk of delirium (adjusted OR: 2.98).
• Addition of CRP improved the area under the receiver operator curve for delirium prediction models, from 0.77 to 0.80 (Model A) and 0.81 to 0.84 (Model B).

Conclusions:

• The integration of CRP into clinical prediction models offers a moderate improvement in forecasting post-stroke delirium.
• C-reactive protein demonstrates potential as a valuable biomarker for risk stratification in stroke patients.
• Further consideration of CRP may aid in refining strategies for delirium prevention and monitoring after stroke.