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Predictive ability of C-reactive protein for early mortality after ischemic stroke: comparison with NIHSS score

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Abstract

We aimed to compare the association of high-sensitivity C-reactive protein (CRP) and National Institutes of Health Stroke Scale (NIHSS) score with mortality risk and to determine the optimal threshold of CRP for prediction of mortality in ischemic-stroke patients. A series of 162 patients with first-ever ischemic-stroke admitted within 24 h after onset of symptoms was enrolled. CRP and NIHSS score were estimated on admission and their predictive abilities for mortality at 7 days were determined by logistic-regression analyses. Receiver-Operating Characteristic (ROC) curves were depicted to identify the optimal cut-off of CRP, using the maximum Youden-index and the shortest-distance methods. Deceased patients had higher levels of CRP and NIHSS on admission (8.87 ± 7.11 vs. 2.20 ± 4.71 mg/l for CRP, and 17.31 ± 6.36 vs. 8.70 ± 4.85 U for NIHSS, respectively, P < 0.01). CRP and NIHSS were correlated with each other (r 2 = 0.39, P < 0.001) and were also independently associated with increased risk of mortality [odds ratios (95 % confidence interval) of 1.16 (1.05–1.28) and 1.20 (1.07–1.35) for CRP and NIHSS, respectively, P < 0.01]. The areas under the ROC curves of CRP and NIHSS for mortality were 0.82 and 0.84, respectively. The CRP value of 2.2 mg/l was identified as the optimal cut-off value for prediction of mortality within 7 days (sensitivity: 0.81, specificity: 0.80). Thus, CRP as an independent predictor of mortality following ischemic-stroke is comparable with NIHSS and the value of 2.2 mg/l yields the optimum sensitivity and specificity for mortality prediction.

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Acknowledgments

This study was performed in partial fulfillment of the requirements for completing residency training of Dr. Shahrzad Mohebbi in neurology and received Grant No. 89-01-54-10354 from vice-chancellor for research of Tehran University of Medical Sciences (TUMS).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, P.O. Box 14197, Tehran, Iran

    Mojdeh Ghabaee, Ali Zandieh, Mohammad Fakhri, Homa Sadeghian, Fatemeh Divani, Mohammadreza Mousavi-Mirkala & Majid Ghaffarpour

  2. Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

    Mojdeh Ghabaee, Shahrzad Mohebbi, Hamed Amirifard & Majid Ghaffarpour

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  1. Mojdeh Ghabaee
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  2. Ali Zandieh
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Correspondence to Mojdeh Ghabaee.

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Ghabaee, M., Zandieh, A., Mohebbi, S. et al. Predictive ability of C-reactive protein for early mortality after ischemic stroke: comparison with NIHSS score. Acta Neurol Belg 114, 41–45 (2014). https://doi.org/10.1007/s13760-013-0238-y

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  • DOI: https://doi.org/10.1007/s13760-013-0238-y

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