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In‐hospital C‐reactive protein predicts outcome after aneurysmal subarachnoid haemorrhage treated by endovascular coiling
Author(s) -
CSAJBOK L. Z.,
NYLÉN K.,
ÖST M.,
SONANDER H.,
NELLGÅRD B.
Publication year - 2015
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12441
Subject(s) - medicine , endovascular coiling , subarachnoid hemorrhage , glasgow outcome scale , c reactive protein , bleed , logistic regression , subarachnoid haemorrhage , aneurysm , prospective cohort study , surgery , endovascular treatment , gastroenterology , glasgow coma scale , inflammation
Background This study aimed to examine prospectively whether the inflammatory marker C ‐reactive protein ( CRP ) increases in patients with aneurysmal subarachnoid haemorrhage ( aSAH ) treated by endovascular coiling and investigate whether CRP could be used as prognostic factor for long‐term neurological outcome. Methods This single‐hospital study comprised 98 consecutive patients with confirmed aSAH treated by endovascular coiling. Admission status was classified according to the W orld F ederation of N eurosurgical S ocieties ( WFNS ) S cale and initial cerebral computed tomography according to F isher scale. CRP was analysed on days 0, 1, 2, 3, 4, 6 and 8 after the initial bleed. A neurological follow up was performed 1 year later according to the E xtended G lasgow O utcome S cale ( GOSE ) for overall outcome and N ational I nstitute of H ealth S troke S cale ( NIHSS ) for focal deficit. Results CRP values increased from normal to peak at 53 mg/l at day 3–4 and then declined, without normalising, at day 8. Patients with a higher increase in CRP had a poorer neurological outcome after 1 year. CRP during the first week had a stronger correlation to outcome (r = 0.417) and NIHSS (r = 0.449) than initial clinical status ( WFNS ; r = 0.280 and 0.274) and radiology ( F isher scale; r = 0.137 and 0.158). CRP increase indicated a risk of poor outcome ( GOSE ) ( P < 0.001) and permanent loss of neurological function ( NIHSS ) ( P < 0.001). Logistic regression analysis suggested that elevated CRP already on day 2 is an independent prognostic marker for outcome. Conclusion Early CRP values can perhaps be used as a prognostic factor for long‐term neurological outcome prediction after endovascular treatment of aSAH .