ABSTRACT NUMBER: ESOC2026YS92 ELEVATED CRP AT PRESENTATION IN ACUTE ISCHAEMIC STROKE IS ASSOCIATED WITH INCREASED MORTALITY INDEPENDENTLY OF CONFOUNDING FACTORS

Abstract Background and aims Elevated initial C-reactive protein (CRP) after acute ischaemic stroke (AIS) is associated with increased mortality. However, the mechanism of this association is unclear: pre-existing comorbidities, delayed presentation or high stroke severity are frequently cited as confounders. As a low-cost biomarker, clarification of CRP's independent prognostic value could support its use in early risk stratification, particularly in resource-limited settings. This study investigated whether the association between (initial post-AIS) CRP and 90-day mortality was independent of comorbidity, delayed presentation and stroke severity. Methods A retrospective cohort study of 853 consecutive patients admitted with AIS to a UK tertiary stroke service between January 2019 and June 2020 was conducted. Data were collected on demographics, comorbidities (using a modified Charlson Comorbidity Index), modified Rankin Scale (mRS), NIHSS, and admission CRP. Patients transferred from other centres and repeat presentations were excluded. Logistic regression and attenuation analyses were employed to investigate the association between admission CRP and mortality, adjusting for comorbidity, delayed presentation and stroke severity. Results Results show elevated CRP at presentation was significantly associated with increased 90-day mortality (p <0.01). Adjustment for confounders gave modest attenuations of the association (NIHSS 17.3%, comorbidity 12.9%, and delayed presentation 5.0%) and CRP remained independently associated with mortality. At the time of submission, cancer was not yet included in the comorbidity analysis; its impact is expected to be marginal and will be evaluated in planned analyses. Subsequent analyses will subdivide causes of elevated CRP into infectious, inflammatory, and unknown categories, and examine associations between CRP and mRS. Conflict of interest Josiah Cho: nothing to disclose. Alvar Paris: nothing to disclose. Eoin O'Brien: nothing to disclose. Robin Brown: nothing to disclose.