Stroke: a raised CRP or increased severity increased the risk of dying or having another vascular event within a year

Clinical bottom line (level 1b)

  1. 30% of patients with a stroke die or have another vascular event within 12 months.
  2. The risk is increased with
    • CRP > 33 mg/dl on admission
    • increasing stroke severity
Di Napoli et al: Stroke 2001; 32 : 133-138
Expires December 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: acute and rehabilitation hospital, Italy

128 patients (aged mean 73, 59% female) with an ischaemic stroke (confirmed on CT or MRI)

Excluded if
  • recent clinical infection
  • concurrent major renal, hepatic disease or cancer
  • surgery or major trauma in previous month
  • obvious signs and clinical evidence of in-hospital-acquired infection
  • haemorrhagic stroke or vasculitis


Factors studied:
  • clinical features including cerebrovascular risk factors and initial stroke severity, 24 hour ECG, blood tests, transoesophageal echocardiography
  • CRP > 33 mg/dl
  • severe stroke functional score: Canadian Neurological Stroke Scale < 6.0

    All patients received secondary prevention with aspirin, ticlopidine or warfarin, and strict control of vascular risk factors.

    Multivariate logistic regression analysis used to adjust for confounding factors.

    ?100% followed for 12 months
    Outcomes studied:
  • death or new vascular event any of myocardial infarction, unstable angina, stroke, transient ischaemic attack

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death or new vascular event 12 months 40/128 31%
    (23% to 39%)    		 3
    (3 to 4)

    prognostic factor for
    death or new vascular event     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    CRP > 33 mg/dl 12 months 40/128
    (31%)     		2.39
    (1.28 to 4.49)     		5
    (3 to 18)
    severe stroke 12 months 40/128
    (31%)     		2.37
    (1.01 to 4.49)     		5
    (3 to 18)

    Citation

    1. Di Napoli M, Papa F, Bocola V: prognostic influence of increased C-reactive protein and fibrinogen levels in ischemic stroke. Stroke 2001; 32 : 133-138
    Search Terms: from ACP Journal Club other articles noted
    Contributor: Chris Ball, December 2001
    Reviewer:

    Clinical Question.
    Patient stroke
    Intervention or Exposure CRP, stroke severity
    Outcome death, vascular event - stroke, TIA, myocardial infarction, angina
    		•