Increased C-reactive protein in acute ischemic stroke patients is age dependent

Marisol Peña Sanchez, Sergio González García, Alina González-Quevedo Monteagudo, Giosmany Bringas Sánchez, James García Benavides, Marianela Arteche Prior, Carlos Maya Entenza, Isabel Fernández Almirall, Anay Cordero Eiriz, María Caridad Menéndez Sainz, Mélany Betancourt Loza, Rebeca Fernández Carriera, Mirelys Peña Nolasco

Texto completo:

PDF (English) XML


Introduction: Several studies investigating blood biomarkers such as C-reactive protein (CRP) in the prognosis and mortality of stroke have not been conclusive. This may be related to the fact that age has not been taken into account for these analyses. 

Objective: In the present study, we evaluated the possible relationship of blood markers with the age and clinical characteristics of ischemic stroke patients. 

Methods: Two groups of acute ischemic stroke patients (≤ 55 years and > 55 years of age) who were paired with a control group were included. CRP, alpha 1 antitrypsin (AAT), complements C3 and C4, microalbuminura, ceruloplasmin, glucose, cholesterol, triglycerides, glutamic-piruvic transaminase (GPT), glutamic-oxalacetic transaminase (GOT), gamma glutamiltranspeptidase (GGT), creatinine, and uric acid were determined. Other clinical information, including NIH stroke scale was collected. 

Results: AAT, ceruloplasmin, microalbuminuria, GPT, GOT and GGT were significantly increased with respect to control subjects in both age groups. Nevertheless, CRP was increased only in patients older than 55 years. CRP and age were directly correlated in stroke patients, but not in the control group joint analysis of age and NIHSS revealed a tendency towards even higher CRP values in older patients with more severe neurological impairment. Levels of CRP increased significantly with age according to NIH score. 

Conclusions: Age should be considered when evaluating the usefulness of CRP and other blood biomarkers as clinical tools for predicting long or short-term neurological outcome or stroke recurrence events in ischemic stroke patients

Palabras clave

C-reactive protein; ischemic attack; stroke; age; neurological deficit


Estel C, Conti CR. Global Burden of Cardiovascular Disease. CVIA 2016; 1(4):369-77.

Feigin VL, Norrving B, Mensah GA. Global Burden of Stroke. Circ Res 2017;120(3):439-48.

Li F, Yang L, Yang R, Xu W, Chen F, Li N, et al. Ischemic Stroke in Young Adults of Northern China: Characteristics and Risk Factors for Recurrence. Eur Neurol 2017;77(34):115-22.

Smajlović D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag 2015;11:157–164.

Montanaro V, Freitas D, Ruiz M, Cavalcanti E, Marinho P, Freitas M, et al. Ischemic Stroke in Young Adults Profile of SARAH Hospital Brasilia From 2008 to 2012. Neurologist 2017;22(2):61-3.

Maaijwee NA, Rutten-Jacobs LC, Arntz RM, Schaapsmeerders P, Schoonderwaldt HC, van Dijk EJ, et al. Long-term increased risk of unemployment after young stroke: a long-term follow-up study. Neurology 2014;83(13):1132-8.

Jickling GC, Sharp FR. Biomarker panels in ischemic stroke. Stroke 2015;46(3): 915–920.

Bustamante A, López-Cancio E, Pich S, Penalba A Giralt D, García-Berrocoso T, et al. Blood Biomarkers for the Early Diagnosis of Stroke. The Stroke-Chip Study. Stroke 2017;48(9):2419-25.

Katan M, Elkind MSV. The potential role of blood biomarkers in patients with ischemic stroke: An expert opinion. Clinical and Translational Neuroscience 2018; 2:1-7.

Brott T, Marler JR, Olinger CP, Adams Jr HP, Tomsick T, Barsan WG, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20(7):864-70.

World Medical Association Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects. JAMA 2013;310(20):2191-4.

Kawle AP, Nayak AR, Lande NH, Kabra DP, Chandak NH, Badar SR, et al. Comparative evaluation of risk factors, outcome and biomarker levels in young and old acute ischemic stroke patients. Ann Neurosci 2015;22(2):70-7.

Yu H, Huang Y, Chen X, Nie W, Wang Y, Jiao Y, et al. High-sensitivity C-reactive protein in stroke patients – The importance in consideration of influence of multiple factors in the predictability for disease severity and death. J Clin Neurosci 2017;36:12-9.

Terni E, Giannini N, Brondi M, Montano V, Bonuccelli U, Mancuso M. Genetics of ischaemic stroke in young adults. BBA Clin 2015;3:96-106.

González-Gómez FJ, Pérez-Torre P, DeFelipe A, Vera R, Matute C, Cruz-Culebras A, et al. Stroke in young adults: Incidence rate, risk factors, treatment and prognosis. Rev Clin Esp 2016(7);216:345-51.

Kefi A, Larbi T, Abdallah M, Ouni AE, Bougacha N, Bouslama K, et al. Young ischemic stroke in Tunisia: a multicentric study. Int J Neurosci 2017;127(4):314-9.

Ferro JM, Massaro AR, Mas JL.Aetiological diagnosis of ischaemic stroke in young adults. Lancet Neurol 2010;9(11):1085-96.

Vila-Corcoles Á, Satue-Gracia E, Ochoa-Gondar O, de Diego-Cabanes C, Vila-Rovira Á, Blade J, et al. Incidence and lethality of ischaemic stroke among people 60 years or older in the region of Tarragona (Spain), 2008-2011. Rev Neurol 2014;59(11):490-6.

Cantú-Brito C, Ruiz-Sandoval JL, Murillo-Bonilla LM, Chiquete E, León-Jiménez C, Arauz A, et al. Acute care and one-year outcome of Mexican patients with first-ever acute ischemic stroke: the PREMIER study. Rev Neurol 2010;51(11):641-9.

Díaz Alfonso H, Sparis Tejido M, Carbó Rodríguez HL, Díaz Ortiz B. Ictus isquémico en pacientes hospitalizados con 50 años o más. Rev Ciencias Médicas. 2015 Dic [access: 17/10/2018];19. Available at:

Muscari A, Collini A, Fabbri E, Giovagnoli M, Napoli C, Rossi V, et al. Changes of liver enzymes and bilirubin during ischemic stroke: mechanisms and possible significance. BMC Neurol 2014;14:122.

Yang W,Kim CK, Kim DY, Jeong HG, Lee SH. Gamma-glutamyl transferase predicts future stroke: A Korean nationwide study. Ann Neurol 2018;83(2):375-86.

Meschia JF. Alpha-1 antitrypsin dysfunction and large artery stroke. Proc Natl Acad Sci USA 2017;114(4):3555-7.

Cojocaru IM, Cojocaru M, Muşuroi C, Druţă A, Băcanu M. Study of some markers of inflammation in atherothrombotic pathogenesis of acute ischemic stroke. Rom J Intern Med 2002;40(1-4):103-16.

Altamura C, Squitti R, Pasqualetti P, Gaudino C, Palazzo P, Tibuzzi F, et al. Ceruloplasmin/Transferrin system is related to clinical status in acute stroke. Stroke 2009;40(4):1282-8.

Chowdhury J, Sultana N, Ahmed S, Rahman MM, Akter M, Rafique T. Microalbuminuria as a Predictor of Short-Term Mortality in Acute Ischemic Stroke. Bangladesh J Med Biochem 2012;5(1):16-9.

Konin B, Konin S, Kinhal SV, Saraf N. Plasma C-reactive protein levels as a prognostic marker in first ever acute ischemic stroke. J Evol Med Dent Sci 2014;3(70):14905-13.

Yeh ET, Willerson JT. Coming of age of C-reactive protein: using inflammation markers in cardiology. Circulation 2003;107(3):370-37.

Verma S, Szmitko PE, Ridker PM. C-reactive protein comes of age. Nat Clin Pract Cardiovasc Med 2005;2(1):29-36.

Liu Y, Wang J, Zhang L, Wang C, Wu J, Zhou Y, et al. Relationship between C-reactive protein and stroke: a large prospective community based study. PLoS One 2014;9(9):e107017.

Feldman M, Sbong S. Is CRP, like ESR, Age and Gender Dependent? Rheumatology (Sunnyvale) 2014;4(2):134.

Mazaheri S, Reisi E, Poorolajal J, Ghiasian M. C-Reactive Protein Levels and Clinical Outcomes in Stroke Patients: A Prospective Cohort Study. Arch Iran Med 2018;21(1):8-12.

Licencia de Creative Commons
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.