Blood C-Reactive Protein Concentration with ABCD2 Is a Better Prognostic Tool than ABCD2 Alone

Autor: Guido Giardini, Massimo Pesenti Campagnoni, Chiara Lia, Adriana Brusa, Giovanni Corso, Massimo Veronese Morosini, Susanna Cordera, Edo Bottacchi
Rok vydání: 2011
Předmět:
Zdroj: Cerebrovascular Diseases. 32:97-105
ISSN: 1421-9786
1015-9770
DOI: 10.1159/000328230
Popis: Background: 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. Methods: 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 ABCD2 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 ABCD2 score and model 2 used serum CRP levels in addition to the ABCD2 score. The primary outcome was an ischaemic stroke. Results: 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 ABCD2 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. Conclusions: 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 ABCD2 score alone.
Databáze: OpenAIRE
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