Association between high-sensitivity C-reactive protein and ischemic stroke outcomes under different glucose metabolism statuses: a retrospective cohort study.

Background: High-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, is associated with clinical outcomes after stroke. This study aimed to explore the relationship between baseline hs-CRP levels and outcomes in patients with acute ischemic stroke (AIS) with different glucose metabolism statuses.

Methods: Using data from the China National Stroke Registry III, patients with AIS or transient ischemic attack were categorized by baseline hs-CRP (low-risk, <1.0 mg/L; average-risk, 1-3 mg/L; and high-risk, >3 mg/L) and glycated hemoglobin A1c (HbA1c)-defined glucose status: normal glucose regulation (NGR), pre-diabetes (pre-DM), and diabetes (DM). The primary outcome was poor functional outcomes (modified Rankin Scale scores of 2-6) at 3 months, with secondary outcomes including poor functional outcomes at 1 year and stroke recurrence at both time points. Multivariable logistic proportional hazards models and restricted cubic spline analysis were used to explore the association between hs-CRP and functional outcomes across glucose metabolism statuses.

Results: This study enrolled 6,916 patients (mean age, 62.4 ± 11.2 years; 67.4% male). Compared with the low-risk group, the high-risk hs-CRP group had a higher risk of poor functional outcomes at 3 months among patients with DM (adjusted odds ratio [aOR] = 1.38, 95% confidence interval [CI] = 1.07-1.77, p = 0.0117) and NGR (aOR = 1.58, 95% CI = 1.19-2.09, p = 0.0015), but not pre-DM (aOR = 1.16, 95% CI = 0.86-1.58, p = 0.3263). A near-linear dose-response relationship was observed in the total population and pre-DM group. No significant associations were found at 1 year or for stroke recurrence.

Conclusions: Glucose metabolism status influenced the association between hs-CRP levels and poor functional outcomes at 3 months after stroke.