C-reactive protein levels at admission among stroke patients - A comparative analysis

Objective

Severity and outcome of stroke may be associated with a concomitant or subsequent inflammatory response. C-reactive protein (CRP) may correlate with length of stay (LOS) in hospital, indicating increased complexity of stroke patients with an ongoing inflammatory reaction upon admission.

Methods

This retrospective cross-sectional study used data from admissions to the non-comprehensive Stroke Unit, which receives patients ineligible for revascularization therapy at Herlev-Gentofte hospital, in 2019 and 2020. We extracted data from electronic health records, including age, sex, diagnosis upon discharge (ICD-10), comorbidities, CRP-level, date and time of admission and discharge. CRP-levels were subcategorized as normal (<10 mg/L), moderate elevation (10–40 mg/L) and high elevation (> 40 mg/L). Discharge diagnosis was subcategorized as acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), or transient ischemic attack (TIA). Statistical analyses were performed in R 4.3.3.

Results

2077 patients were included, whereof 1169 had AIS, 831 had TIA and 77 had ICH. 97 had CRP > 40 mg/L, 249 had CRP 10–40 mg/L and 1574 had normal CRP-levels, whereas CRP-levels were unavailable in 157 cases. Our adjusted analysis revealed that CRP-levels > 40 mg/L were associated with longer LOS compared to CRP-levels 0–10 mg/L. No significant association was found between CRP-levels 10–40 mg/L and a longer LOS. Age ≥ 65 years and ICH were associated with prolonged LOS, whereas TIA and COVID-19 lockdown periods were associated with shorter LOS.

Conclusion

The study demonstrates the potential of CRP as a prognostic marker for increased LOS in hospital among patients with acute stroke or TIA.