RESUMO
High-sensitivity C-reactive protein [hs-CRP], an acute phase reactant, is an indicator of underlying systemic inflammation and a novel marker for atherothrombotic disease. This study was designed to evaluate serum levels of hs-CRP in acute ischemia stroke and its relation to stroke severity in the first 24 hours. Also, this study aimed to asses the relationship between hs-CRP levels and blood pressure [BP] in the acute phase of ischemic stroke. Sixty patients were recruited in three groups. Twenty patients with first ever ischemic stroke and history of hypertension were selected to represent group I. Group II included 20 patients with the first ever stroke, with no history of hypertension, with normal BP on regular measurements prior to stroke and presented with acute rise of BP. Twenty hypertensive patients with no history of stroke or ischemic heart diseases represented group III. For comparison, 20 healthy volunteers were included as control group. All subjects were submitted to detailed history taking, thorough general and neurological examination with paying special attention to BP. Stroke severity was assessed using the Canadian Neurological Scale [CANS]. The infarcts size was evaluated in CT and/or MRI. Serum levels of hs-CRP were measured using end point CRP-turbidoemetric assay. Serum levels of hs-CRP were significantly higher among patients of group I [t = 6.01, p<0.001], group II [t = 6.39, p<0.001] and group III [t = 2.91, p<0.01] in comparison with controls. The highest significant elevation was observed among stroke patients with acute rise of BP while; the modest was among patients with isolated hypertension. CRP levels showed significant negative correlation with the CANS score [r = -0.72, p<0.001], and significant positive correlation with the size of brain infarcts [r = 0.68, p<0.001]. There was highly significant positive correlation between hs-CRP levels and BP components; systolic BP [SBP], diastolic BP [DBF], mean arterial pressure [MAP] and pulse pressure [PP] in all patient groups. However, when displaying the multivariate adjusted logistic regression model assessing the association between all BP components and odds of having elevated CRP levels, only 10 mmHg rise in SBP significantly persisted to increase the odds of having an elevated CRP by 76% [odds ratio, 3.76; 95% confidence interval, 1.97-5.35; P<0.001]. Ischemic stroke can trigger an acute phase response expressed by elevation of circulating hs-CRP serum levels which may correlate with the size of infarcts and the severity of stroke. In the acute phase of ischemic stroke, hypertension, more specifically acute rise of BP, is associated with increased levels of hs-CRP which may correlate with BP components most prominent with SBP