Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Association between high-sensitivity C-reactive protein, functional disability, and stroke recurrence in patients with acute ischaemic stroke: A mediation analysis
First author：Hong-Qiu Gu
Corresponding author：Zi-Xiao Li
essential_information
- Person in charge：Hong-Qiu Gu
- Data Sources： CNSR-Ⅲ
- Number of papers：CNSR-Ⅲ20220103
- Published time：2022-05-13
2022-05-13
Published articles
Journal：eBioMedicine
Publication type: Original Contributions
IF(IF): 11.205
PMID: 35576642 Link To Pubmed Full text Download
Background And Purpose
Post-stroke inflammation biomarker high-sensitivity C-reactive protein (hsCRP) increases cerebral infarct size and results in functional disability directly, it also contributes to the formation and maturation ofatherosclerotic plaques, which increase the risk of stroke recurrence and results in functional disability indirectly. However, no study has quantified how much functional disability was mediated by stroke recurrence.
Method
Patients with acute ischaemic stroke within 7 days and admitted to 169 hospitals in the Third China National Stroke Registry were analyzed. Blood samples were collected within 24 h of admission. Stroke recurrence and functional disability (defined as a modified Rankin scale score 2) were assessed via face-to-face interviews at three months. Mediation analysis under the counterfactual framework was performed to examine the potential causal chain in which stroke recurrence may mediate the relationship between hsCRP and functional outcome. Sensitivity analyses were performed across different subgroups and on different scales ofhsCRP measurement.
Conclusion
Stroke recurrence mediates less than 20% of the association between hsCRP and functional disability at 90 days among patients with acute ischaemic stroke. In addition to typical secondary prevention strategies for preventing stroke recurrence, more attention should be paid to novel anti-inflammatory therapy to improve functional outcomes.
Main results
Of the 7603 analyzed patients (mean [SD] age, 62.3 [11.3] years; 2392 [31.5%] women), the median (interquartile range [IQR]) ofNIHSS score was 3.0 (1.06.0). The median (IQR) level ofhsCRP was 1.73 (0.814.38) mg/ L. A total of496 (6.5%) cases of stroke recurrence and 1884 (24.8%) cases of functional disability were observed at the 90-day follow-up. Each SD increase in the concentration of hsCRP was associated with an increased risk of stroke recurrence (adjusted odds ratio [aOR], 1.11; 95% CI, 1.041.18) and disability (aOR, 1.14; 95% CI, 1.081.20) within 90 days. Of 1884 functionally disabled patients, only 16.0 % (n = 302) of patients experienced stroke recurrence before functional disability. Stroke recurrence during follow-up explained 16.52% (95% CI, 5.79%27.25%) of the relationship between hsCRP and functional disability. Sensitivity analyses in different subgroups and on different scales ofhsCRP measurement showed comparable results.