Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage

Abstract BACKGROUND: There remains a proportion of patients with unfavorable outcomes after aneurysmal subarachnoid hemorrhage, of particular relevance in those who present with a good clinical grade. A forewarning of those at risk provides an opportunity towards more intensive monitoring, investigation, and prophylactic treatment prior to the clinical manifestation of advancing cerebral injury. OBJECTIVE: To assess whether biochemical markers sampled in the first days after the initial hemorrhage can predict poor outcome. METHODS: All patients recruited to the multicenter Simvastatin in Aneurysmal Hemorrhage Trial (STASH) were included. Baseline biochemical profiles were taken between time of ictus and day 4 post ictus. The t-test compared outcomes, and a backwards stepwise binary logistic regression was used to determine the factors providing independent prediction of an unfavorable outcome. RESULTS: Baseline biochemical data were obtained in approximately 91% of cases from 803 patients. On admission, 73% of patients were good grade (World Federation of Neurological Surgeons grades 1 or 2); however, 84% had a Fisher grade 3 or 4 on computed tomographic scan. For patients presenting with good grade on admission, higher levels of C-reactive protein, glucose, and white blood cells and lower levels of hematocrit, albumin, and hemoglobin were associated with poor outcome at discharge. C-reactive protein was found to be an independent predictor of outcome for patients presenting in good grade. CONCLUSION: Early recording of C-reactive protein may prove useful in detecting those good grade patients who are at greater risk of clinical deterioration and poor outcome.

Download Full-text

The Postoperative C-reactive Protein Level can be a Useful Prognostic Factor for Poor Outcome and Symptomatic Vasospasm in Patients With Aneurysmal Subarachnoid Hemorrhage

Journal of Neurosurgical Anesthesiology ◽

10.1097/ana.0b013e31826047a2 ◽

2012 ◽

Vol 24 (4) ◽

pp. 317-324 ◽

Cited By ~ 27

Author(s):

Young-Tae Jeon ◽

Ju-Hyun Lee ◽

Hannnah Lee ◽

Hye-Kyoung Lee ◽

Jung-Won Hwang ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Prognostic Factor ◽

Protein Level ◽

Aneurysmal Subarachnoid Hemorrhage ◽

C Reactive Protein ◽

Reactive Protein ◽

Poor Outcome ◽

Symptomatic Vasospasm

Download Full-text

Serum C-reactive protein levels predict neurological outcome after aneurysmal subarachnoid hemorrhage

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2012000300009 ◽

2012 ◽

Vol 70 (3) ◽

pp. 202-205 ◽

Cited By ~ 11

Author(s):

Flávio Ramalho Romero ◽

Eduardo de Freitas Bertolini ◽

Eberval G. Figueiredo ◽

Manoel Jacobsen Teixeira

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

C Reactive Protein ◽

Clinical Prognosis ◽

Protein Levels ◽

Reactive Protein ◽

Fisher Grade ◽

Serial Serum ◽

Gcs Score ◽

Serum Crp

OBJECTIVES: Our aim was to evaluate the relationship between serum C-reactive protein (CRP) levels and the neurological prognosis and development of vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS: Eighty-two adult patients with aSAH diagnoses were prospectively evaluated. Glasgow Coma Scale (GCS) score, Hunt and Hess grade, Fisher grade, cranial CT scans, digital subtraction angiography studies and daily neurological examinations were recorded. Serial serum CRP measurements were obtained daily between admission and the tenth day. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS) were used to assess the prognosis. RESULTS: Serum CRP levels were related to severity of aSAH. Patients with lower GCS scores and higher Hunt and Hess and Fisher grades presented statistically significant higher serum CRP levels. Patients with higher serum CRP levels had a less favorable prognosis. CONCLUSIONS: Increased serum CRP levels were strongly associated with worse clinical prognosis in this study.

Download Full-text

Is C-reactive protein useful as a predictor for poor outcome after aneurysmal subarachnoid hemorrhage?

Acta Neurochirurgica ◽

10.1007/s00701-012-1343-z ◽

2012 ◽

Vol 154 (6) ◽

pp. 1011-1012

Author(s):

Hosam Al-Jehani ◽

Jeanne Tietelbaum

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

C Reactive Protein ◽

Reactive Protein ◽

Poor Outcome

Download Full-text

Effect of Clipping, Craniotomy, or Intravascular Coiling on Cerebral Vasospasm and Patient Outcome after Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽

10.1227/01.neu.0000137628.51839.d5 ◽

2004 ◽

Vol 55 (4) ◽

pp. 779-789 ◽

Cited By ~ 84

Author(s):

Brian L. Hoh ◽

Mehmet A. Topcuoglu ◽

Aneesh B. Singhal ◽

Johnny C. Pryor ◽

James D. Rabinov ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Hospital Mortality ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Poor Grade ◽

Poor Outcome ◽

Symptomatic Vasospasm ◽

Fisher Grade ◽

Significant Difference ◽

Good Grade ◽

Grade 3

Abstract OBJECTIVE: Although several recent studies have suggested that the incidence of vasospasm after aneurysmal subarachnoid hemorrhage is lower in patients undergoing aneurysmal coiling as compared with clipping, other studies have had conflicting results. We reviewed our experience over 8 years and assessed whether clipping, craniotomy, or coiling affects patient outcomes or the risk for vasospasm. METHODS: We included 515 patients with aneurysmal subarachnoid hemorrhage, identified prospectively from November 2000 to February 2003 (243 patients) and retrospectively from November 1995 to October 2000 (272 patients), by using International Classification of Diseases, 9th Revision, codes for subarachnoid hemorrhage. We classified patients as follows: clipping (413 patients), coiling (79 patients), and craniotomy (436 patients, including all 413 patients who underwent clipping plus 23 who underwent coiling as well as craniotomy for various reasons). We studied four outcome measures: total vasospasm, symptomatic vasospasm, poor outcome (modified Rankin score 3–6), and in-hospital mortality. To assess the risk of total vasospasm and symptomatic vasospasm, we performed multivariate regression analyses adjusting for age, Fisher grade, Hunt and Hess grade, aneurysm location (anterior versus posterior circulation), and aneurysm treatment modality. To assess the risk for poor outcome and in-hospital mortality, we adjusted for all the above variables as well as for total and symptomatic vasospasm. RESULTS: In the clipping group there was 63% total vasospasm and 28% symptomatic vasospasm; in the coiling group there was 54% total vasospasm and 33% symptomatic vasospasm; and in the craniotomy group there was 64% total vasospasm and 28% symptomatic vasospasm. In the multivariate analysis, age <50 years (P = 0.0099) and Fisher Grade 3 (P < 0.00001) predicted total vasospasm, and Fisher Grade 3 (P < 0.000001) and Hunt and Hess Grade IV or V (P = 0.018) predicted symptomatic vasospasm. Predictors of poor outcome were age ≥50 years (P < 0.0001), Fisher Grade 3 (P = 0.0072), Hunt and Hess Grade IV or V (P < 0.00001), symptomatic vasospasm (P < 0.0001), and coiling (P = 0.0314 versus clipping and P = 0.045 versus craniotomy). Predictors of in-hospital mortality were age ≥ 50 years (P = 0.0030), Hunt and Hess Grade IV or V (P = 0.0001), symptomatic vasospasm (P < 0.00001), and coiling (P = 0.008 versus clipping and P = 0.0013 versus craniotomy). There was no significant difference in total vasospasm or symptomatic vasospasm when patients who underwent clipping or craniotomy were compared with patients who underwent coiling. In patients with Hunt and Hess Grade I to III (“good grade”), clipping and craniotomy were associated with better outcome and less in-hospital mortality, but there was no difference in total vasospasm or symptomatic vasospasm versus coiling. In patients with Hunt and Hess Grade IV or V (“poor grade”), there was no difference in any outcome measure among the treatment groups. CONCLUSION: In a single-center, retrospective, nonrandomized study, performance of clipping and/or craniotomy had significantly better outcome and lower mortality at discharge than coiling in good-grade patients but had no effect on total vasospasm or symptomatic vasospasm in good- or poor-grade patients.

Download Full-text

Possible Role of the C-Reactive Protein and White Blood Cell Count in the Pathogenesis of Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Journal of Neurosurgical Anesthesiology ◽

10.1097/01.ana.0000181693.30750.af ◽

2006 ◽

Vol 18 (1) ◽

pp. 68-72 ◽

Cited By ~ 55

Author(s):

Ralf Dirk Rothoerl ◽

Cornelia Axmann ◽

Ana-Luisa Pina ◽

Chris Woertgen ◽

Alexander Brawanski

Keyword(s):

Subarachnoid Hemorrhage ◽

Blood Cell ◽

Cell Count ◽

Cerebral Vasospasm ◽

White Blood Cell Count ◽

Aneurysmal Subarachnoid Hemorrhage ◽

C Reactive Protein ◽

Blood Cell Count ◽

Reactive Protein

Download Full-text

Variation of patient characteristics, management, and outcome with timing of surgery for aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2010.11.jns10795 ◽

2011 ◽

Vol 114 (4) ◽

pp. 1045-1053 ◽

Cited By ~ 13

Author(s):

Kelly B. Mahaney ◽

Michael M. Todd ◽

James C. Torner

Keyword(s):

Subarachnoid Hemorrhage ◽

Management Practices ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Timing Of Surgery ◽

Early Surgery ◽

Outcome Variable ◽

Optimal Time ◽

World Federation ◽

Time Interval ◽

Fisher Grade

ObjectThe past 30 years have seen a shift in the timing of surgery for aneurysmal subarachnoid hemorrhage (SAH). Earlier practices of delayed surgery that were intended to avoid less favorable surgical conditions have been replaced by a trend toward early surgery to minimize the risks associated with rebleeding and vasospasm. Yet, a consensus as to the optimal timing of surgery has not been reached. The authors hypothesized that earlier surgery, performed using contemporary neurosurgical and neuroanesthesia techniques, would be associated with better outcomes when using contemporary management practices, and sought to define the optimal time interval between SAH and surgery.MethodsData collected as part of the Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) were analyzed to investigate the relationship between timing of surgery and outcome at 3 months post-SAH. The IHAST enrolled 1001 patients in 30 neurosurgical centers between February 2000 and April 2003. All patients had a radiographically confirmed SAH, were World Federation of Neurosurgical Societies Grades I–III at the time of surgery, and underwent surgical clipping of the presumed culprit aneurysm within 14 days of the date of hemorrhage. Patients were seen at 90-day follow-up visits. The primary outcome variable was a Glasgow Outcome Scale score of 1 (good outcome). Intergroup differences in baseline, intraoperative, and postoperative variables were compared using the Fisher exact tests. Variables reported as means were compared with ANOVA. Multiple logistic regression was used for multivariate analysis, adjusting for covariates. A p value of less than 0.05 was considered to be significant.ResultsPatients who underwent surgery on Days 1 or 2 (early) or Days 7–14 (late) (Day 0 = date of SAH) fared better than patients who underwent surgery on Days 3–6 (intermediate). Specifically, the worst outcomes were observed in patients who underwent surgery on Days 3 and 4. Patients who had hydrocephalus or Fisher Grade 3 or 4 on admission head CT scans had better outcomes with early surgery than with intermediate or late surgery.ConclusionsEarly surgery, in good-grade patients within 48 hours of SAH, is associated with better outcomes than surgery performed in the 3- to 6-day posthemorrhage interval. Surgical treatment for aneurysmal SAH may be more hazardous during the 3- to 6-day interval, but this should be weighed against the risk of rebleeding.

Download Full-text

The clinical profile, management, and overall outcome of aneurysmal subarachnoid hemorrhage at the neurosurgical unit of a tertiary care center in India

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.131650 ◽

2014 ◽

Vol 5 (02) ◽

pp. 118-126 ◽

Cited By ~ 6

Author(s):

Harsimrat Bir Singh Sodhi ◽

Amey R. Savardekar ◽

Sandeep Mohindra ◽

Rajesh Chhabra ◽

Vivek Gupta ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Care Center ◽

Tertiary Care ◽

Intervention Group ◽

World Federation ◽

Tertiary Care Center ◽

Multinomial Regression ◽

Poor Outcome

ABSTRACT Background and Purpose: Several studies report good outcomes in selected patients of aneurysmal subarachnoid hemorrhage (aSAH). The purpose of our study is to project the clinical characteristics, management, and overall outcome of patients with aSAH presenting to a tertiary care center in India. Materials and Methods: A prospective study was conducted over a period of 10 months and all patients presenting with aSAH were studied. Patients presenting in all grades and managed with any type of intervention or managed conservatively were included to characterize their clinical and radiological profile at admission, during management, and at discharge. Outcome was assessed with the Glasgow Outcome Score (GOS) at 3 months follow-up. Results: Out of the 482 patients [mean age: 51.3 (±13.5); M: F = 1:1], 330 patients were fit to be taken up for intervention of the ruptured aneurysm, while 152 patients were unfit for any intervention. At 3 months follow-up, good outcome (GOS 4 and 5) was observed in 159 (33%), poor outcome (GOS 2 and 3) in 53 (11%), and death in 219 (45.4%) patients, while 51 patients (10.6%) were lost to follow-up. Most (95%) of the patients in the non-intervention group expired, and hence the high mortality rate, as we have analyzed the results of all patients of all grades, regardless of the treatment given. The predictors of poor outcome (GOS 1, 2, and 3) at 3 months follow-up, using multinomial regression model, were: World Federation of Neurological Surgeons (WFNS) grade IV and V (at admission and after adequate resuscitation) [odds ratio (OR): 35.1, 95% confidence interval (CI): 10.8-114.7] and presence of hypertension as a co-morbid illness [OR: 2.7, 95% CI: 1.6-5.6]. All patients showing acute infarction on computed tomography scan at presentation had a poor outcome. Conclusions: Despite recent advances in the treatment of patients with aSAH, the morbidity and mortality rates have failed to improve significantly in unselected patients and natural cohorts. This may be attributed to the natural history of aSAH, and calls for new strategies to diagnose and treat such patients before the catastrophe strikes.

Download Full-text