Comparison of acute versus convalescent stage high-sensitivity C-Reactive protein level in predicting clinical outcome after acute ischemic stroke and impact of erythropoietin

Totally 160 patients were prospectively randomized to receive either EPO therapy (group 1, n = 80) (5,000 IU each time, subcutaneously) at 48 h and 72 h after acute IS, or placebo (group 2, n = 80). Serum level of hs-CRP was determined using ELISA at 48 h and on day 21 after IS and once in 60 healthy volunteers.Serum level of hs-CRP was substantially higher in all patients with IS than in healthy controls at 48 h and day 21 after IS (all p < 0.001). Levels of hs-CRP did not differ between group 1 and 2 at 48 h and day 21 after IS (all p > 0.5). Multivariate analysis showed that hs-CRP levels (at 48 h and day 21) were independently predictive of 90-day major adverse neurological event (MANE) (defined as recurrent stroke, NIHSS≥8, or death) (all p < 0.03), whereas EPO therapy was independently predictive of reduced 90-day MANE (all p < 0.02).EPO therapy which was independently predictive of freedom from 90-day MANE did not alter the crucial role of hs-CRP levels measured at 48 h and 21-day in predicting unfavorable clinical outcome after IS.Numerous studies have already shown that inflammation plays a crucial role in the initiation of endothelial dysfunction, atherosclerosis and plaque formation, propagation of plaque burden, and finally, rupture of the vulnerable plaque and acute arterial obstructive syndrome (AOS) [1-4]. Although a myriad of inflammatory biomarkers have been reported to be useful in predicting endothelial dysfunction and the likelihood of AOS, high-sensitivity C-reactive protein (hs-CRP) remains one of the most extensively studied and widely accepted inflammatory biomarkers in our daily clinical practice [4-10].Indeed, not only is hs-CRP an inflammatory biomarker, but it has also been proved to directly participate in the inflammatory process contributing to acute AOS [3,4,7]. Besides, immense clinical observational studies have demonstrated that serum level of hs-CRP is a useful and powerful inflammatory marker in predicting future cardiovascular a