In:
Cerebrovascular Diseases, S. Karger AG, Vol. 32, No. 2 ( 2011), p. 97-105
Abstract:
〈 i 〉 Background: 〈 /i 〉 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. 〈 i 〉 Methods: 〈 /i 〉 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 ABCD 〈 sup 〉 2 〈 /sup 〉 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 ABCD 〈 sup 〉 2 〈 /sup 〉 score and model 2 used serum CRP levels in addition to the ABCD 〈 sup 〉 2 〈 /sup 〉 score. The primary outcome was an ischaemic stroke. 〈 i 〉 Results: 〈 /i 〉 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 ABCD 〈 sup 〉 2 〈 /sup 〉 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. 〈 i 〉 Conclusions: 〈 /i 〉 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 ABCD 〈 sup 〉 2 〈 /sup 〉 score alone.
Type of Medium:
Online Resource
ISSN:
1015-9770
,
1421-9786
Language:
English
Publisher:
S. Karger AG
Publication Date:
2011
detail.hit.zdb_id:
1482069-9
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