Assessment of Changes in Serum C-Reactive Protein Levels in Patients after Ischemic Stroke Undergoing Rehabilitation-A Retrospective Observational Study

Wojciech Borowicz; Kuba Ptaszkowski; Lucyna Ptaszkowska; Eugenia Murawska-Ciałowicz; Joanna Rosińczuk

doi:10.3390/jcm12031029

Assessment of Changes in Serum C-Reactive Protein Levels in Patients after Ischemic Stroke Undergoing Rehabilitation-A Retrospective Observational Study

J Clin Med. 2023 Jan 29;12(3):1029. doi: 10.3390/jcm12031029.

Authors

Wojciech Borowicz^{1

2}, Kuba Ptaszkowski³, Lucyna Ptaszkowska⁴, Eugenia Murawska-Ciałowicz⁵, Joanna Rosińczuk²

Affiliations

¹ Department of Pediatric Infectious Diseases, Wroclaw Medical University, 50-368 Wroclaw, Poland.
² Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland.
³ Department of Physiotherapy, Wroclaw Medical University, 50-368 Wroclaw, Poland.
⁴ Institute of Health Science, University of Opole, Katowicka 68, 45-060 Opole, Poland.
⁵ Physiology and Biochemistry Department, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland.

Abstract

Inflammation plays a key role in the pathogenesis and prognosis of ischemic stroke. C-reactive protein (CRP) is an inflammatory biomarker of inflammation and may reflect the progression of vascular disease. Using a biomarker such as CRP to predict recovery rather than mortality may present clinical value in providing rehabilitation. The primary aim of the study was to analyze changes in serum CRP levels in patients after ischemic stroke during the regenerative-compensatory period and to assess the usefulness of CRP as a potential biomarker during the rehabilitation period. The project was carried out as a retrospective analysis of prospectively collected data from post-stroke patients from the Department of Neurological Rehabilitation of the Regional Specialist Hospital in Wrocław. A group of 52 patients, after their first-ever ischemic stroke with subsequent hemiplegia, was finally qualified to participate in the study. Serum CRP levels were determined during blood laboratory tests. The Modified Rankin Scale (mRS) and Barthel Index (BI) were used to assess functional outcomes. Rehabilitation using neurophysiological methods was applied five days a week (each session lasted 60 min, and the entire period was 42 days). At the first test, serum CRP levels were found to be above 5 mg/L in 19 patients, the second test in 12 patients, the third test in five patients, and the fourth test in 9 patients. Only three patients had values higher than 5 mg/L in all consecutive assessments (p > 0.05). There was a statistically significant increase in BI scores after therapy (p < 0.001) as well as a decrease in the mRS score by 2.2 points (p < 0.001), in CRP values by 5.02 mg/L (p = 0.019), and in cortisol levels by 2.5 nmol/L (p = 0.002). Statistically significant relationships were observed between the CRP levels after rehabilitation and the corresponding mRS scores (rs = 0.29, p = 0.038). Furthermore, the effect of BMI on CRP levels was demonstrated (B = 0.20, p = 0.038). In conclusion, despite demonstrating a significant relationship between CRP levels and corresponding mRS scores, CRP levels alone may not serve as an independent predictor of long-term functional outcomes in ischemic stroke patients undergoing rehabilitation.

Keywords: C-reactive protein; biomarkers; functional outcomes; rehabilitation; stroke.

Grants and funding

This research was funded by an internal grant of the Wroclaw University of Health and Sport Sciences, Poland (project no. 503 62/05): The effectiveness of various therapeutic forms and their influence on nervous, muscular and vascular plasticity in patients after ischemic stroke. The APC was funded by the Ministry of Health subventions according to the number of SUBZ.E250.23.020 from the IT Simple system of the Wroclaw Medical University in Poland.