Hs-CRP, D-dimer And Fibrinogen In The Role Of Differentiating Etiological Subtypes Of Ischemic Stroke

Objective:To evaluate the diagnostic value of serum biochemical markers including high-sensitivity C-reactive protein (hs-CRP), D-dimer (DD) and fibrinogen (Fg) to differentiate etiological subtypes of ischemic stroke.Methods:As a retrospective case only study, all patients hospitalized with acute ischemic stroke were selected from Department of Neurology, the First Affiliated Hospital of Jinan University from January 2009 to December 2010. According to the medical records, collected clinical data of all patients, including hs-CRP, DD, Fg and other helpful data. All patients were classified into subtypes according to NEW-TOAST classification. And statistical analysis were performed with SPSS for Windows, version 13.0.Results:A total of 317 consecutive patients were evaluated. Of these,162 with atherothrombosis (AT) counted for 51.10%,37 with cardioembolism (CE) counted for 11.67%,62 with small artery disease (SAD) counted for 19.56%,3 with other determined etiology (SOD) counted for 0.95%, and 53 with undetermined etiology counted for 16.72%. Hs-CRP and DD levels were both significantly different among the subtypes (P<0.05), which were both highest in CE, followed by AT, SAD. But the level of Fg in each subtype was no significant difference (P=0.416). The ROC curves obtained to select the cutoff values that offered the best sensitivity and specificity for differentiating CE from other subtypes identified the following values:hs-CRP= 6.96mg/L, DD=791.30ng/mL. And the cutoff point for discriminating the presence or absence of CE was determined to be hs-CRP>6.96mg/L with a sensitivity of 41%, a specificity of 74%; and DD>791.30ng/mL with a sensitivity of 58%, a specificity of 78%. The combination of hs-CRP and DD had a sensitivity of 65% and a specificity of 91% for predicting CE. By multivariate logistic regression analysis, DD>791.30ng/mL was an independent predictive factors of CE (OR 6.825,95% CI: 2.955～15.766, P=0.000). Conclusions:Hs-CRP and DD could be useful for identifying the etiological subtypes of acute ischemic stroke, especially for predicting CE. Using a combination of hs-CRP and DD may be a feasible strategy to improve the diagnosis of CE in the acute phase.