There is increasing evidence that inflammation plays a role in the
pathogenesis of aneurysmal subarachnoid hemorrhage (aSAH) and in the
development of delayed cerebral ischemia (DCI). However, the
assessment and interpretation of classically defined inflammatory
parameters is difficult in aSAH patients. The objective of this
study was to investigate the relationship between easily assessable
findings (hyperventilation, fever, white blood cell count (WBC), and
C-reactive protein (CRP)) and the occurrence of DCI and unfavorable
neurological outcome at discharge in aSAH patients.
Retrospective analysis of prospectively collected data from a single
center cohort. We evaluated the potential of clinical signs of
inflammation (hyperventilation, fever) and simple inflammatory
laboratory parameters CRP and WBC to predict unfavorable outcomes at
discharge and DCI in a multivariate analysis. A cutoff value for CRP
was calculated by Youden's J statistic. Outcome was measured using
the modified Rankin score at discharge, with an unfavorable outcome
defined as modified Rankin scale (mRS) > 3.
We included 97 consecutive aSAH patients (63 females, 34 males, mean
age 58 years) in the analysis. Twenty-one (22%) had major
disability or died by the time of hospital discharge. Among
inflammatory parameters, CRP over 100 mg/dl on day 2 was an
independent predictor for worse neurological outcome at discharge.
The average C-reactive protein level in the first 14 days was
higher in patients with a worse neurological outcome (96.6, SD 48.3
vs 56.3 mg/dl, SD 28.6) in the first 14 days after aSAH.
C-reactive protein on day 2 was an indicator of worse neurological
outcome. No inflammatory parameter was an independent predictor of
DCI. After multivariate adjustment, DCI, increased age, and more
than 1 day of mechanical ventilation were significant
predictors of worse neurological outcome.
Early elevated CRP levels were a significant predictor of worse
neurological outcome at hospital discharge and may be a useful
marker of later deterioration in aSAH.
Alessandro O, Warschkow R, Stefan W, Filipovic M, Seule M, Oliver B,
Pietsch U. C-reactive protein elevation predicts in-hospital
deterioration after aneurysmal subarachnoid hemorrhage: a
retrospective observational study. Acta Neurochir (Wien) 2022;.