Combination of Hs-CRP and Homocysteine Levels as Predictors of Short-term Outcome in Acute Ischemic Stroke

Background: Apart from the traditional risk factors associated with stroke, several newer independent risk markers that are promising targets for modification, such as hyperhomocysteinemia, and elevated high-sensitive C-reactive protein (hs-CRP), may contribute significantly to the stroke risk.The role of elevated levels of inflammatory markers in predicting prognosis after a first ischemic stroke has been a gray area.The present study aimed to assess the clinical outcome of acute ischemic stroke patients in particular relation to hs-CRP and homocysteine (Hcy) levels within 48 hours of presentation.Methods: A prospective, observational study was carried out among admitted and diagnosed patients with acute ischemic stroke confirmed by CT/MRI scans where included patients were subjected to detailed history taking using pretested and predesigned pro forma along with thorough clinical examination using CT scan brain (non-contrast)/MRI brain.High-sensitive C-reactive protein and Hcy levels and other blood parameters were done within 48 hrs of hospital admission.Patients were scored based on the National Institute of Health Stroke Scale (NIHSS) at specified time points to assess the clinical outcome.Results were statistically analyzed.Results: Patients of cerebral infarction with elevated hs-CRP had a lower improvement score in contrast to those with non-elevated hs-CRP, who had a higher improvement.Also, patients with an elevated Hcy level had a lower mean improvement score at day 30 compared to those with normal Hcy levels.With the increasing size of the infarct, there was a lower improvement score.The higher the admission NIHSS score, the lower the improvement score in the study.High-sensitive C-reactive protein proved to be the strongest predictor for score improvement with other predictor variables like infarct size, NIHSS baseline score and Hcys also showing positive association.Conclusion: High-sensitive C-reactive protein alone comes out as the strongest predictor for the improvement in NIHSS score from the time of admission to a 30-day progress period with a prediction power of 98%.