Incremental value of serum inflammatory biomarkers to carotid atherosclerotic plaque burden for prediction of ipsilateral ischemic stroke recurrence

Background The relationship between serum inflammatory biomarkers, carotid atherosclerotic plaque characteristics, and the recurrence of ischemic events remains a subject of ongoing debate. Purpose To investigate whether the combination of carotid atherosclerotic plaque burden and serum inflammatory biomarkers could help predict ipsilateral ischemic stroke recurrence. Material and Methods Patients with cerebral infarction were prospectively recruited and received three-dimensional vessel wall imaging (VWI). Baseline serum level of high-sensitivity C-reactive protein (hs-CRP) and the neutrophil-to-lymphocyte ratio (NLR) was recorded. Plaque burden was independently measured by two trained readers. Stroke recurrence was assessed at 1 year after discharge. Factors associated with stroke recurrence were analyzed. Receiver operating characteristic curves were used to calculate areas under the curve (AUCs) of inflammatory biomarkers and plaque burden for predicting stroke recurrence. Results A total of 56 patients were included, with recurrence in nine patients. hs-CRP (odds ratio [OR] = 1.60, 95% confidence interval [CI] = 1.17–2.19; P = 0.017) and carotid normalized wall index (NWI) (OR = 1.08, 95% CI = 1.01–1.16; P = 0.023) were found associated with stroke recurrence. Multivariate logistic regression showed that hs-CRP (OR = 1.67, 95% CI = 1.17–2.38; P = 0.005) and NWI (OR = 1.10, 95% CI = 1.01–1.20, P = 0.023) remained associated with stroke recurrence. Hs-CRP (AUC = 0.806; P = 0.002) and NWI (AUC = 0.738; P <0.001) were predictors of stroke recurrence. The combination of hs-CRP with NWI (AUC = 0.811, P <0.001) demonstrated the best performance in terms of predicting stroke recurrence. Conclusion Both hs-CRP and NWI were independently associated with stroke recurrence. The combination of hs-CRP and NWI may be a good predictor of 1-year stroke recurrence.