The Predictive Value of hs-C-Reactive Protein Is Based on the Presence of Antiphospholipid Antibodies.

High-sensitive C-reactive protein (hs-CRP) is a marker of inflammation which has been shown in several prospective studies to predict independently myocardial infarction, stroke or peripheral artery disease. Patients with antiphospholipid antibodies (aPL) are at increased risk of recurrent thromboembolic events but the possibility to predict such risk seems rather limited. Recently, similarities were found in the pathology of thrombosis between elevated levels of hs-CRP and the presence of aPL.We studied the predictive role of hs-CRP levels in patients with the presence of aPL of a cohort of patients with neurological manifestations compared to those where aPL could be excluded.

Patients A follow-up investigation was done in 55 aPL-positive and 61 aPL -negative, sex- and age matched patients of the same cohort of patients with acute manifestations of neurological diseases. Hs-CRP levels were measured in all patients at enrollment and were related to the outcome of the patients after a median time of 32 months.

Methods Lupus anticoagulants were detected according to the SSC of the ISTH. Anticardiolipin tests were performed by a ß2-glycoprotein I-dependent enzyme-linked immunsorbent assay (Pharmacia ELISA). Hs-CRP was measured by latex enhanced turbidometry (dimension RXL, Dade Behring).

Results Cerebral infarctions and transient ischemic attacks were the most common cerebral manifestations of the patients. In APS patients elevated levels of hs-CRP could be measured significantly more frequently than in patients where aPL could be excluded (44 % vs. 16 %, p<0.005). The rate of recurrences or severe residual symptoms was higher in patients with aPL (45 %) compared to 32 % in aPL-negative patients. In non APS patients hs-CRP levels were not associated to the occurrence of future neurological events. In patients with aPL elevated levels of hs-CRP were highly associated to an increased rate of recurrent or residual symptoms (OR, 12.5; 95 % CI, 3.72 to 41.94) and not related to other risk factors, except of smoking (p<0.05).

Conclusion Elevated levels of hs-CRP were associated to the presence of aPL and related to the risk of recurrences in these patients but not in patients where the presence of aPL could be excluded. In patients with APS elevated levels of hs-CRP may identify a group of patients at high risk of recurrent or residual neurological symptoms who may benefit from a more careful follow-up and antithrombotic therapy.