Skip to main content Skip to main navigation menu Skip to site footer

The correlation between C-Reactive Protein, Vascular Cell Adhesion Molecule-1, and S100b with Alberta stroke program early CT Score in non-hemorrhagic stroke patients


Background: Stroke is the leading cause of disability and the second-most cause of death in Indonesia, caused by atherosclerotic obstructions in the cerebral and cervical arteries. C-reactive protein (CRP) is an acute-phase protein synthesized after the stimulation of the pro-inflammatory cytokines. Vascular cell adhesion molecule 1 (VCAM-1) is a sign of both inflammation and atherosclerosis. S100B protein is the dominant protein in the central nervous system released in the event of inflammation in the brain, such as stroke. CT-scan is a gold-standard diagnosis of non-hemorrhagic stroke. However, it has a limit to the onset of <6 hours. The Alberta stroke program early CT-score (ASPECTS) system enhances non-contrast CT-scan sensitivity in assessing early ischemic changes in areas supplied by the middle cerebral artery (MCA). The correlation between inflammatory variables and ischemic assessments on CT-scan needs to be analyzed further. This study aimed to prove the correlation between acute inflammatory signs and ischemic assessment using ASPECTS in non-hemorrhagic stroke patients.

Methods: This study was a cross-sectional study conducted in April-September 2019 on 47 non-hemorrhagic stroke patients in Diponegoro National Hospital, Telogorejo Hospital, and Tugurejo Hospital, Semarang. The diagnosis of non-hemorrhagic stroke was based on the non-contrast CT-scan and subsequent ASPECTS assessment. CRP, VCAM-1, and S100B levels were examined using the ELISA principle. The correlation test between variables was also performed employing the Spearman test.

Results: The correlation test results between the CRP, VCAM-1, and S100B levels with the ASPECTS were r = -0.035, p = 0.815; r = -0.117, p = 0,432; and r = 0.145, p = 0.332, respectively.

Conclusions: There was no significant correlation between the CRP, VCAM-1, and S100B levels with the ASPECTS. The increase in CRP and S100B inflammatory signs was not accompanied by low ASPECTS assessment, which depended on the appearance of lesions on the CT-scan.


  1. Prabal D, Suash S, KM H. Pathophysiologic mechanisms of acute ischemic stroke: An overview with emphasis on therapeutic significance beyond thrombolysis. ISP Pathophysiology. 2010;17:197–218.
  2. Feigin VL, Norrving B, Mensah GA. Global Burden of Stroke. Circ Res. 2017;120(3):439–48.
  3. Damian GH, Chalapati R, Nguyen PH. Stroke mortality variations in South-East Asia : Empirical evidence from the field. Int J Stroke. 2013;A-100:21–7.
  4. Mensah GA, Norrving B, Feigin VL. The Global Burden of Stroke. Neuroepidemiology. 2015;45(3):143-5. doi: 10.1159/000441082.
  5. Misbach J, Ali W. Stroke in Indonesia: a first large prospective hospital-based study of acute stroke in Indonesia's 28 hospitals. J Clin Neurosci. 2001;8(3):245-9. doi: 10.1054/jocn.1999.0667.
  6. Kusuma Y, Venketasubramanian N, Kiemas LS, Misbach J. Burden of stroke in Indonesia. Int J Stroke. 2009;4(5):379-80. doi: 10.1111/j.1747-4949.2009.00326.x.
  7. Kanyal N. The Science of Ischemic Stroke: Pathophysiology & Pharmacological Treatment. Int J Pharma. 2015;4(410):65–84.
  8. Brandt T, Seinke W, Thie A. Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome. Cerebrovascular disease. 2000;10:170-2.
  9. Peisker T, Koznar B, Stetkarova I, Widimsky P. Acute stroke therapy: A review. Trends Cardiovasc Med. 2017;27(1):59-66. doi: 10.1016/j.tcm.2016.06.009.
  10. Zaremba J, Skrobański P, Losy J. Acute ischaemic stroke increases the erythrocyte sedimentation rate, which correlates with early brain damage. Folia Morphol (Warsz). 2004;63(4):373-6.
  11. Murni RI, Pudjonarko D, Satoto B, Imawati S. Correlation of erythrocyte sedimentation rate and ASPECTS value in ischemic stroke patients. MKA;2015:38(1):26-32.
  12. Demchuk AM, Hill MD, Barber PA, Silver B, Patel SC, Levine SR; NINDS rtPA Stroke Study Group, NIH. Importance of early ischemic computed tomography changes using ASPECTS in NINDS rtPA Stroke Study. Stroke. 2005;36(10):2110-5. doi: 10.1161/01.STR.0000181116.15426.58.
  13. Kisialiou A, Pelone G, Carrizzo A, Grillea G, Trimarco V, Marino M, Bartolo M, De Nunzio AM, Grella R, Landolfi A, Puca A, Colonnese C, Vecchione C. Blood biomarkers role in acute ischemic stroke patients: higher is worse or better? Immun Ageing. 2012;31;9(1):22. doi: 10.1186/1742-4933-9-22.
  14. Abd BA. Mean platelet volume and its influence on the severity of acute ischemic stroke. Medical Journal of Babylon .2014;11(3):500-506.
  15. Wagner DD, Burger PC. Platelets in Inflammation and Thrombosis. Arterioscler Thromb Vasc Biol. 2003;23(12):2131–7.
  16. Hertog HM, van Rossum JA, van der Worp HB, van Gemert HMA, de Jonge R, Koudstaal PJ. C-reactive protein in the very early phase of acute ischemic stroke: association with poor outcome and death. J Neurol. 2009;256(12):2003–8.
  17. Ikra V. Role of Mean platelet volume in thrombotic stroke. J Majority.2015;4(2):129-32.17.
  18. Dewan KR, Rana PVS. C–reactive Protein and Early Mortality in Acute Ischemic Stroke.Kathmandu Univ Med J. 2011;36(4):252–5.
  19. Shah PA, Mir RA, Kamili MMA, Bardi GH, Masoodi ZA. Role of Mean Platelet Volume in Ischemic Stroke. JK Sci. 2013;15(3):136–9.
  20. Neki NS, Jain A. A Study of Association of Mean Platelet Volume and Ischaemic Stroke. Asian Pac J Health Sci. 2016;3(4):212–9.
  21. Akıl E, Akıl MA, Varol S, et al. Echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio are novel inflammatory predictors of cerebral ischemic stroke. J Stroke Cerebrovasc Dis. 2014;23:2328-34.
  22. Lu S, Ge M, Zheng Y, Li J, Feng X, Feng S, Huang J, Feng Y, Yang D, Shi J, Chen F, Han Z. CD106 is a novel mediator of bone marrow mesenchymal stem cells via NF-κB in the bone marrow failure of acquired aplastic anemia. Stem Cell Res Ther. 2017;8(1):178. doi: 10.1186/s13287-017-0620-4.
  23. Ley K, Huo Y. VCAM-1 is critical in atherosclerosis.The Journal of Clinical Investigation. 2001;107(10):1209-10
  24. Tchalla AE, Wellenius GA, Travison TG, Gagnon M, Iloputaife I, Dantoine T, et al. Circulating Vascular Cell Adhesion Molecule-1 (sVCAM-1) Is Associated with Cerebral Blood Flow Dysregulation, Mobility Impairment, and Falls in Older Adults. Hypertension. 2015;66(2):340–346.
  25. Licata G, Tuttolomondo A, Di Raimondo D, Corrao S, Di Sciacca R, Pinto A. Immuno-inflammatory activation in acute cardio-embolic strokes in comparison with other subtypes of ischaemic stroke. Thrombosis and haemostasis. 2009;101(5):929-37.
  26. Elsayed AM, Mohamed GA. Mean platelet volume and mean platelet volume/platelet count ratio as a risk stratification tool in the assessment of severity of acute ischemic stroke. Alexandria J Med. 2017;53(1):67–70.
  27. Sherif M, Esmael A, Abd-El Salam O. Diagnostic and Prognostic Significance of Blood Biomarkers in Acute Ischemic Stroke. Int Neuropsychiatr Dis J. 2016;6(1):1–11.
  28. Donato R, Sorci G, Riuzzi F, Arcuri C, Bianchi R, Brozzi F, Tubaro C, Giambanco I. S100B's double life: intracellular regulator and extracellular signal. Biochim Biophys Acta. 2009;1793(6):1008-22. doi: 10.1016/j.bbamcr.2008.11.009.
  29. Kumar H, Lakhotia M, Pahadiya H, Singh J, Sangappa JR. Correlation of serum S-100 protein level with involvement of territory and size of lesion in acute ischemic stroke. 2016;3:16–9.
  30. Liswati E, Wijaya A, Ranakusuma TAS. Biochemical Markers for Differential Diagnosis of Stroke: A Biochemical Markers Study of S100B Protein, Neuron Specific Enolase (NSE), Myelin Basic Protein (MBP), and Heart-Type Fatty Acid Binding Protein (H-FABP). Indones Biomed J. 2009;1(1):68–72.
  31. Cakmak AV, Gunduz A, Karaca Y, Alioglu Z, Mentese A, Topbas M. Diagnostic Significance of Ischemia-Modified Albumin, S100b, and Neuron-Specific Enolase in Acute Ischemic Stroke. J Acad Emerg Med. 2014;112–7.
  32. Beer C, Blacker D, Bynevelt M, Hankey GJ, Puddey IB. Systemic markers of inflammation are independently associated with S100B concentration: results of an observational study in subjects with acute ischaemic stroke. J Neuroinflammation. 2010;7:71. doi: 10.1186/1742-2094-7-71.
  33. Yardan T, Erenler AK, Baydin A, Aydin K, Cokluk C. Usefulness of S100B protein in neurological disorders. J Pak Med Assoc. 2011;61(3):276–81.
  34. Selcuk O, Yayla V, Cabalar M, Guzel V, Uysal S, Gedikbasi A. The Relationship of Serum S100B Levels with Infarction Size and Clinical Outcome in Acute Ischemic Stroke Patients. Neuropsychiatry Archive. 2014;51(4):395–400.
  35. Di Napoli M, Papa F, Bocola V. C-reactive protein in ischemic stroke: an independent prognostic factor. Stroke. 2001;32:917–24
  36. Smith CJ, Emsley HC, Vail A. Variability of the systemic acute phase response after ischemic stroke. J Neurol Sci. 2006;251:77–81.
  37. Huo Y, Ley K. Adhesion molecules and atherogenesis. Acta Physiol Scand. 2001;173:35-43.
  38. Paffen E, deMaat MPM. C-reactive protein in atherosclerosis: A causal factor? Cardiovasc Res. 2006;71(1):30–9.
  39. Fang C, Lou B, Zhou J, Zhong R, Wang R, Zang X. Blood biomarkers in ischemic stroke: Role of biomarkers in differentiation of clinical phenotype. Eur J Inflamm. 2018;16:1-10.
  40. Richard S, Lagerstedt L, Burkhard PR, Debouverie M, Turck N, Sanchez JC. E-selectin and vascular cell adhesion molecule-1 as biomarkers of 3-month outcome in cerebrovascular diseases. J Inflamm (Lond). 2015;12:61. doi: 10.1186/s12950-015-0106-z.
  41. Supanc V, Biloglav Z, Basic KV, Demarin V. Role of cell adhesion molecules in acute ischemic stroke.Ann Saudi Med. 2011;31(4):365-370.
  42. Topakian R, Strasak AM, Nussbaumer K. Prognostic value of admission C-reactive protein in stroke patients undergoing iv thrombolysis. J Neurol. 2008;255:1190–96.
  43. Winbeck K, Poppert H, Etgen T. Prognostic relevance of early serial C-reactive protein measurements after first ischemic stroke. Stroke. 2002;33:2459–64.

How to Cite

Retnoningrum, D., Wati, A. P., Rahmawati, M. B., Ningrum, F. H., Kuntjoro, L. P. W. S., & Limijadi, E. K. S. (2021). The correlation between C-Reactive Protein, Vascular Cell Adhesion Molecule-1, and S100b with Alberta stroke program early CT Score in non-hemorrhagic stroke patients. Bali Medical Journal, 10(1), 377–381.




Search Panel

Dwi Retnoningrum
Google Scholar
BMJ Journal

Arinta Puspita Wati
Google Scholar
BMJ Journal

Maria Belladonna Rahmawati
Google Scholar
BMJ Journal

Farah Hendara Ningrum
Google Scholar
BMJ Journal

Lydia Purna Widyastuti Setjadiningrat Kuntjoro
Google Scholar
BMJ Journal

Edward Kurnia Setiawan Limijadi
Google Scholar
BMJ Journal