Introduction and objective:
Fibrinogen (FIB) and C-reactive protein (CRP) play an important role in any inflammatory response. FIB levels may be higher in stroke patients compared to non-stroke patients. CRP is used to detect inflammation due to its high sensitivity in aseptic inflammation. Blood levels of d-dimer (DD) are used to determine the amount of fibrin formed and distributed. Inflammation may play an important role in the pathogenesis of haemorrhagic stroke causing primal da-mage, and in ischemic stroke causing secondary damage due to a decrease in perfusion in the brain. The aim of the study is to prove the hypothesis that the inflammatory process is involved in the pathogenesis of ischemic and haemorrhagic stroke.

Material and methods:
The study used data from a retrospective study conducted on a group of 402 stroke patients, among which the levels of FIB, CRP and DD were compared. The patients were hospitalized in the Department of Neurology of the Medical University (MU) in Białystok from 1 January – 31 December 2016. Patients’ data was obtained from medical records. The diagnosis of stroke was confirmed by CT of the head. Patients with other brain injuries were excluded from the study. The study was approved by the Bioethics Committee of the MU of Bialystok. The applied research method was the statistical method.

A positive moderate correlation was found between CRP and FIB. In the group of patients with ischemic stroke it was higher (0.59) than in the group of patients with haemorrhagic stroke(0.22). Moreover, in the group of patients with ischemic stroke, a correlation was found between DD and CRP(0.517).

Inflammatory process is involved in pathogenesis of ischemic and haemorrhagic stroke, but could be associated with comorbid diseases. Increased CRP correlates with higher levels of FIB and DD in the ischemic stroke but not in the haemorrhagic stroke.

Pieters M, Wolberg AS. Fibrinogen and fibrin: An illustrated review. Research and Practice in Thrombosis and Haemostasis. 2019; 3: 161–72.
Liu Y, Chen H, Zhao K, et al. High levels of plasma fibrinogen are related to post-stroke cognitive impairment. Brain and Behavior. 2019; 9: e01391.
Menti E, Zaffari D, Galarraga T, Conceição e Lessa JR da, Pontin B, Pellanda LC, et al. Early markers of atherosclerotic disease in individuals with excess weight and dyslipidemia. Arquivos Brasileiros de Cardiologia. 2016; 106: 457–63.
Muddathir ARM, Abd Alla MI, Khabour OF. Waterpipe smoking is associated with changes in fibrinogen, FVII, and FVIII Levels. Acta Haematologica. 2018; 140: 159–65.
Ansar W, Ghosh S. Biology of C Reactive Protein in Health and Disease: Publication Finder UMB. Springer: India; 2016.
Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflam-mation and infection. Frontiers in Immunology. 2018; 9 APR.
Zhang J, Wu Y, Gao Z. Correlations of c-reactive protein (CRP), in-terleukin-6 (IL-6), and insulin resistance with cerebral infarction in hypertensive patients. Medical Science Monitor. 2019; 25: 1506–11.
Weitz JI, Fredenburgh JC, Eikelboom JW. A Test in Context: D-Dimer. Journal of the American College of Cardiology. 2017; 70: 2411–20.
Wiseman S, Marlborough F, Doubal F, Webb DJ, Wardlaw J. Blood markers of coagulation, fibrinolysis, endothelial dysfunction and inflammation in lacunar stroke versus non-lacunar stroke and non-stroke: Systematic review and meta-analysis. Cerebrovascular Diseases. 2014; 37: 64–75.
Boursin P, Maïer B, Paternotte S, et al. Semantics, epidemiology and semiology of stroke. Soins. 2018; 63: 24–7.
Jayaraj RL, Azimullah S, Beiram R, et al. Neuroinflammation: Friend and foe for ischemic stroke. Journal of Neuroinflammation. 2019; 16.
Mo Y, Sun YY, Liu KY. Autophagy and inflammation in ischemic stroke. Neural Regeneration Research. 2020; 15: 1388–96.
Zhu H, Wang Z, Yu J, et al. Role and mechanisms of cytokines in the secondary brain injury after intracerebral hemorrhage. Progress in Neurobiology. 2019; 178: 101610.
Unnithan AKA, Mehta P. Hemorrhagic Stroke. StatPearls Publishing; 2021.
Liu L Bin, Li M, Zhuo WY, et al. The role of Hs-CRP, D-dimer and fibrinogen in differentiating etiological subtypes of ischemic stroke. PLoS ONE. 2015; 10.
Melake MS, El-Kabany RA, Al-Emam AI, et al. The Role of D-Dimer, Fibrinogen and C-Reactive Protein as Plasma Biomarkers in Acute Ischemic Stroke. Journal of Neurology Research. 2015; 5: 277–82.
Zang RS, Zhang H, Xu Y, et al. Serum C-reactive protein, fibrinogen and D-dimer in patients with progressive cerebral infarction. Translational Neuroscience. 2016; 7: 84–8.
Vibo R, Kõrv J, Roose M, et al. Acute phase proteins and oxidised low-density lipoprotein in association with ischemic stroke subtype, severity and outcome. Free Radical Research. 2007; 41: 282–7.
Eidelman RS, Hennekens CH. Fibrinogen: A predictor of stroke and marker of atherosclerosis. European Heart Journal. 2003; 24: 499–500.
Siegerink B, Rosendaal FR, Algra A. Genetic variation in fibrinogen; its relationship to fibrinogen levels and the risk of myocardial infarction and ischemic stroke. Journal of Thrombosis and Haemostasis. 2009; 7: 385–90.
Shenhar-Tsarfaty S, Assayag E Ben, Bova I, et al. Persistent hyperfibri-nogenemia in acute ischemic stroke/temporary ischemic attack (TIA). Thrombosis and Haemostasis. 2008; 99: 169–73.
Whiteley W, Jackson C, Lewis S, et al. Association of circulating in-flammatory markers with recurrent vascular events after stroke: A prospective cohort study. Stroke. 2011; 42: 10–6.
Sato S, Iso H, Noda H, et al. Plasma Fibrinogen Concentrations and Risk of Stroke and Its Subtypes Among Japanese Men and Women. 2006.
Woodward M, Lowe GDO, Campbell DJ, et al. Associations of inflammatory and hemostatic variables with the risk of recurrent stroke. Stroke. 2005; 36: 2143–7.
Matsumoto M, Sakaguchi M, Okazaki S, et al. Relationship between plasma D-dimer level and cerebral infarction volume in patients with nonvalvular atrial fibrillation. Cerebrovascular Diseases. 2013; 35: 64–72.
Huţanu A, Iancu M, Bǎlaşa R, Maier S, Dobreanu M. Predicting functional outcome of ischemic stroke patients in Romania based on plasma CRP, sTNFR-1, D-Dimers, NGAL and NSE measured using a biochip array article. Acta Pharmacologica Sinica. 2018; 39: 1228–36.
Folsom AR, Gottesman RF, Appiah D, et al. Plasma d-dimer and in-cident ischemic stroke and coronary heart disease: The atherosclerosis risk in communities study. Stroke. 2016; 47: 18–23.
Dabrowska S, Andrzejewska A, Lukomska B, et al. Neuroinflamma-tion as a target for treatment of stroke using mesenchymal stem cells and extracellular vesicles. Journal of neuroinflammation.
Zhou Y, Han W, Gong D, et al. Hs-CRP in stroke: A meta-analy-sis. Clinica Chimica Acta. 2016; 453: 21–7.
Das S, Roy S, Kaul S, et al. CRP Gene (1059G>C) Polymorphism and Its Plasma Levels in Ischemic Stroke and Hemorrhagic Stroke in a South Indian Population. Inflammation. 2014; 37: 1683–8.
Xue Y, Zhang L, Fan Y, et al. C-Reactive Protein Gene Contributes to the Genetic Susceptibility of Hemorrhagic Stroke in Men: a Case-Control Study in Chinese Han Population. Journal of Molecular Neuroscience. 2017; 62: 395–401.
Habib SS, Al Masri AA. Relationship of high sensitivity C-reactive protein with presence and severity of coronary artery disease. Pakistan Journal of Medical Sciences. 2013; 29.
DuBrock HM, AbouEzzeddine OF, Redfield MM. High-sensitivity C-reactive protein in heart failure with preserved ejection fraction. PLoS ONE. 2018; 13. doi: 10.1371/journal.pone.0201836.
Bos MJ, Schipper CMA, Koudstaal PJ, et al. High serum C-reactive protein level is not an independent predictor for stroke: The Rotterdam Study. Circulation. 2006; 114: 1591–8.
Makalesi A, Akköse Aydın Ş, Köksal Ö, et al. Clinical Value Of D--Dimer and Other Coagulation Markers in Differantial Diagnosis of Hemorrhagic and Ischemic Stroke Hemorajik ve İskemik İnme Ayırıcı Tanısında D-Dimer ve Diğer Koagülasyon Belirteçlerinin Değerliliği.
Alexandru R, Terecoasă EO, Băjenaru OA, et al. Etiologic classification of ischemic stroke: Where do we stand? Clinical Neurology and Neurosurgery. 2017; 159: 93–106.
Luyendyk JP, Schoenecker JG, Flick MJ. The multifaceted role of fi-brinogen in tissue injury and inflammation. Blood. 2019; 133: 511–20.
Venkat P, Shen Y, Chopp M, Chen J. Cell-based and pharmacological neurorestorative therapies for ischemic stroke. Neuropharmacology. 2018; 134 Pt B: 310–22.
Refaai MA, Riley P, Mardovina T, Bell PD. The Clinical Significance of Fibrin Monomers. Thrombosis and Haemostasis. 2018; 118: 1856–66.
Kreutz RP, Owens J, Breall JA, et al. C-reactive protein and fibrin clot strength measured by thrombelastography after coronary stenting. Blood Coagulation and Fibrinolysis. 2013; 24: 321–6.
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