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. 2025 Jul 19:23969873251357134.
doi: 10.1177/23969873251357134. Online ahead of print.

Association of CRP levels and clinical and radiological outcomes in patients with large-vessel occlusion stroke: A MR CLEAN Registry study

Yan Wang  1 , Sven Pr Luijten  2 , Daniel Bos  2   3 , Inge A Mulder  4 , Manon Kappelhof  5 , Willeke F Westendorp  1 , Bart J Emmer  5 , Stefan D Roosendaal  5 , Yvo Bwm Roos  1 , Ido R van den Wijngaard  6   7 , Robert J van Oostenbrugge  8 , Diederik van de Beek  1 , Jonathan M Coutinho  1
Affiliations

Association of CRP levels and clinical and radiological outcomes in patients with large-vessel occlusion stroke: A MR CLEAN Registry study

Yan Wang et al. Eur Stroke J. .

Abstract

Introduction: Inflammation is important in the pathogenesis of acute ischemic stroke (AIS). The association between CRP and outcomes in patients with large vessel occlusion (LVO) stroke receiving endovascular therapy (EVT) has not been fully elucidated.

Patients and methods: We used data from the MR CLEAN Registry (2014-2017), including LVO-AIS patients with intracranial carotid atherosclerotic disease (ICAD), extracranial carotid atherosclerotic disease (ECAD) or atrial fibrillation (AF). The primary outcome was modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included mRS ⩾3 at 90 days, all-cause mortality, successful recanalization, and symptomatic intracranial hemorrhages. CRP was analyzed both dichotomously (>3.0 vs ⩽3.0 mg/L) and continuously, using multivariable regression adjusted for potential confounders.

Results: Among 865 included patients (ICAD: 286; ECAD: 154; AF: 425), median CRP level was 3.4 mg/L (IQR: 2.0-6.1) and 446 patients had elevated CRP (>3.0 mg/L). AF patients had higher CRP than ICAD and ECAD patients (4.0-3.0-3.2 mg/L, p = 0.002). CRP >3.0 mg/L was not associated with mRS in the full cohort (acOR 0.983, 95% CI (0.767, 1.260)) or in any etiological subgroups (ICAD: acOR = 0.968, 95% CI (0.626, 1.496), ECAD: acOR = 1.114, 95% CI (0.617, 2.012), AF: acOR = 0.937, 95% CI (0.653, 1.344)). There was also no association between CRP and any of the other outcomes. When analyzed as a continuous variable, CRP was also not associated with any other outcomes.

Conclusions: We did not observe an association between CRP levels and clinical and radiological outcomes after LVO stroke.

Keywords: C-reactive protein; acute ischemic stroke; endovascular treatment; large vessel occlusion; stroke etiology.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Emmer reports receiving funding from Healthcare Evaluation Netherlands, and Health Holland. Dr Roos reports being a minor shareholder of Nicolab. Dr Wijngaard reports receiving compensation from Philips and Medtronic for consultancy services. Dr Mulder reports receiving the Dutch Heart Foundation 2021 E. Dekker Grant (03-006-2021-T019). Dr van de Beek reports receiving funding from the Netherlands Scientific Organization and the ItsME Foundation. Dr Coutinho reports receiving funding from the Netherlands Thrombosis Foundation, grants from Bayer and AstraZeneca, and is co-founder and shareholder of TrianecT. The other authors report no conflicts of interest.

Figures

Graphical abstract
Graphical abstract
The image is a flowchart for patient selection.
Figure 1.
Flowchart for patient selection.
Distribution of patients on the modified Rankin scale at 90 days and according to high and low CRP levels, and other medical conditions.
Figure 2.
Distribution of patients on the modified Rankin scale at 90 days. (a) The distribution of patients grouped by high and low CRP levels. (b) The distribution of three subgroups based on high and low CRP levels. High CRP: CRP level >3.0 mg/L; low CRP: CRP level ⩽3 mg/L; ICAD: intracranial carotid atherosclerotic disease; ECAD: extracranial carotid atherosclerotic disease; AF: atrial fibrillation.
See this image and copyright information in PMC

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