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Procalcitonin Is a Stronger Predictor of Long-Term Functional Outcome and Mortality than High-Sensitivity C-Reactive Protein in Patients with Ischemic Stroke

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Abstract

Inflammatory markers have been associated with functional outcome and mortality of stroke. We investigated the changes in procalcitonin (PCT) and high-sensitivity C-reactive protein (Hs-CRP) levels during the acute period of ischemic stroke and evaluated the relationship between these levels and the long-term functional outcome and mortality. We prospectively studied 376 patients with acute ischemic stroke (AIS) who were admitted within 24 h after the onset of symptoms. PCT, Hs-CRP, and NIH Stroke Scale (NIHSS) were measured at the time of admission. Long-term functional outcome were measured by modified Rankin scale (mRS) at 1 year after admission. The correlations between the levels of PCT, Hs-CRP, and mortality at 1 year after stroke onset were analyzed. Patients with poor with functional outcome and non-survivors had significantly increased PCT and Hs-CRP levels on admission. Multivariate logistic regression analysis showed that PCT was an independent prognostic marker of 1-year functional outcome and death [odds ratio (OR) 2.33 (95 % CI, 1.33–3.44) and 3.11 (2.02–4.43), respectively, P < 0.0001 for both, adjusted for age, NIHSS, other predictors, and vascular risk factors] in patients with AIS. The area under the receiver operating characteristic curve of PCT was 0.77 (95 % CI, 0.72–0.83) for functional outcome and 0.88 (95 % CI, 0.84–0.93) for mortality. PCT improved the area under the receiver operating characteristic curve of the NIHSS score for functional outcome from 0.74 (95 % CI, 0.66–0.81) to 0.85 (95 % CI, 0.76–0.92; P < 0.0001) and for mortality from 0.77 (95 % CI, 0.70–0.83) to 0.94 (95 % CI, 0.89–0.97; P < 0.0001). Serum level of PCT at admission was an independent predictor of long-term functional outcome and mortality after ischemic stroke in Chinese sample.

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Acknowledgments

We also express our gratitude to all the patients who participated in this study and thereby made this work possible.

Authors’ Contributions

Li-Hong Li had full access to all the data in the study and is responsible for the integrity of the data and the accuracy of the data analyses. Chao Wang, Li Gao, and Zhi-Guo Zhang contributed in the study concept and design and drafting of the manuscript. Zhi-Guo Zhang, Yu-Qian Li, Yan-Long Yang, and Tao-Chang Zheng contributed in the acquisition of data. J Chao Wang, Li Gao, Zhi-Guo Zhang, Long-Long Zheng, Xing-Ye Zhang, and Ming-Hao Man contributed in the analysis and interpretation of data. Li-Hong Li contributed in the critical revision of the manuscript for important intellectual content, and administrative support. All authors have read, edited, and approved the final version of the manuscript.

Conflict of Interest

The authors have no relevant potential conflicts of interest to declare.

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    Authors and Affiliations

    1. Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, No. 1, Xinsi Road, Baqiao District, Xi’an, Shaanxi Province, 710038, People’s Republic of China

      Chao Wang, Li Gao, Zhi-Guo Zhang, Yu-Qian Li, Yan-Long Yang, Tao Chang, Long-Long Zheng, Xing-Ye Zhang, Ming-Hao Man & Li-Hong Li

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    1. Chao Wang
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    Chao Wang, Li Gao, and Zhi-Guo Zhang contributed equally to this study.

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    Wang, C., Gao, L., Zhang, ZG. et al. Procalcitonin Is a Stronger Predictor of Long-Term Functional Outcome and Mortality than High-Sensitivity C-Reactive Protein in Patients with Ischemic Stroke. Mol Neurobiol 53, 1509–1517 (2016). https://doi.org/10.1007/s12035-015-9112-7

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