TITLE:
C-Reactive Protein as a Prognostic Marker in Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis
AUTHORS:
Yingzi Wang, Xia’en Fang, Binhao Zhang, Yao Liu, Yibo Yu, Zhaoyin Su, Yatao Liu, Nerlich Michael
KEYWORDS:
C-Reactive Protein, Intracerebral Hemorrhage, Prognostic Marker, Meta-Analysis
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.13 No.10,
October
30,
2025
ABSTRACT: Background:Intracerebral hemorrhage (ICH) is a devastating subtype of stroke with high rates of morbidity and mortality. Inflammation is a key driver of secondary brain injury following ICH, and C-reactive protein (CRP) is a cardinal biomarker of systemic inflammation. While numerous studies have investigated the prognostic role of CRP in ICH, its utility remains a subject of debate, with conflicting findings across the literature. Objective: This systematic review and meta-analysis aimed to synthesize the available evidence and quantitatively assess the association between CRP levels and adverse clinical outcomes in patients with spontaneous ICH. Methods: A comprehensive literature search was conducted in PubMed, Embase, SinoMed, and the Cochrane Library from inception to June 2026. We included observational studies that evaluated the association between CRP levels and subsequent poor outcomes in adult patients with spontaneous ICH. Two independent reviewers performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Common and Random effects models were used to pool odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated with funnel plots. Results: A total of 15 observational studies involving 14,285 patients met the inclusion criteria. The qualitative assessment indicated that most studies were of moderate to high quality. The meta-analysis revealed that elevated CRP levels were significantly associated with an increased risk of poor outcome (pooled OR: 1.27, 95% CI: 1.06 - 1.51, p 2 = 90.3%). Similarly, high CRP levels were a significant predictor of poor functional outcome (pooled OR: 1.19, 95% CI: 1.04 - 1.35, p 2 = 84.3%) and mortality (pooled OR: 1.51, 95% CI: 1.08 - 2.12, p 2 = 84.3%). High CRP levels were a significant predictor of early hematoma growth (pooled OR: 1.11, 95% CI: 1.06 - 1.17, p 2 = 0%). Sensitivity analyses confirmed the robustness of the primary findings. There was no evidence of significant publication bias. Conclusion: This systematic review and meta-analysis provides strong evidence that elevated CRP levels are independently associated with a higher risk of poor outcome in patients with spontaneous ICH. CRP is an accessible, inexpensive, and valuable biomarker that can aid in early risk stratification and may help identify patients who could benefit from targeted anti-inflammatory therapies.