The predictive role of serum C-reactive protein level for hemorrhagic transformation after acute cerebral infarction
LI Lijuan
SHU Chang
WANG Lu
Abstract：Objective To investigate the association between serum C-reactive protein(CRP)levels and the occurrence of hemorrhagic transformation(HT)after acute cerebral infarction,and to acess its potential predictive value.Methods This retrospective cohort study consecutively enrolled 458 patients with acute cerebral infarction admitted to the Department of Neurology,West China Hospital of Sichuan University from June 1st,2023 to December 31st,2024.Based on serum C-reactive protein(CRP)levels measured within 24 h of admission,patients were stratified into a low-CRP group(<10 mg/L,n=245)and a high-CRP group(≥10 mg/L,n=213)using a cutoff value of 10 mg/L.The primary endpoint was radiologically confirmed hemorrhagic transformation(HT)during hospitalization.Baseline characteristics,clinical characteristics,laboratory parameters,and imaging data were collected and compared between the two groups.Independent determinants of HT were identified by univariable and multivariable logistic regression,and the discriminative performance of CRP for incident HT was quantified with ROC curve analysis.Results Among 458 enrolled patients,126 patients(27.5%)developed HT.The high-CRP group(≥10 mg/L)demonstrated a significantly higher HT incidence than the low-CRP group(38.5%vs 18.0%,P<0.001).These patients were older,had higher baseline NIHSS scores,and showed higher prevalence of atrial fibrillation,coronary disease,diabetes,and reperfusion therapy.After multivariable adjustment,elevated CRP(≥10 mg/L)remained an independent predictor for HT(OR=1.91,95%CI:1.16-3.14,P=0.011).Other independent risk factors included large MCA infarction(OR=3.76),atrial fibrillation(OR=2.62),and reperfusion therapy(OR=3.94).Stratified analysis revealed a significant interaction between CRP and reperfusion status(P-interaction=0.030).Elevated CRP significantly predicted HT only in patients receiving reperfusion therapy(OR=4.51,95%CI:1.84-11.02,P=0.001).The AUC of CRP for HT prediction was 0.642(95%CI:0.586-0.697).Conclusion Elevated early-stage serum CRP(≥10 mg/L)is an independent risk factor for HT in acute cerebral infarction,demonstrating significant interaction with reperfusion therapy.Routine CRP monitoring can flag high-risk individuals and refine post-admission management.
Keywords：C-reactive proteinacute cerebral infarctionhemorrhagic transformationrisk factorsprediction
Publication Date：2025-12-20
Online Publishing Date：2026-01-07(First online date of this platform, not the publication date of the document)
Pages：7( 1457-1463 )