C-reactive protein and vasospasm after aneurysmal subarachnoid hemorrhage.

Flávio Ramalho Romero,Daniele Cristina Cataneo,Antonio José Maria Cataneo

doi:10.1590/s0102-86502014000500009

Flávio Ramalho Romero, Daniele Cristina Cataneo + Show 1 more

Open Access

https://doi.org/10.1590/s0102-86502014000500009

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Abstract

To evaluate the relationship between C reactive protein levels and clinical and radiological parameters with delayed ischemic neurological deficits and outcome after aneurysmal subarachnoid hemorrhage. One hundred adult patients with aneurismal SAH were prospectively evaluated. Besides the baseline characteristics, daily C-reactive protein levels were prospectively measured until day 10 after subarachnoid hemorrhage. The primary end point was outcome assessed by Glasgow Outcome Scale, the secondary was the occurrence of delayed ischemic neurological deficits (DINDs). A progressive increase in the CRP levels from the admission to 3rd postictal day was observed, followed by a slow decrease until the 9th day. Hemodynamic changes in TCD were associated with higher serum CRP levels. Patients with lower GCS scores presented with increased CRP levels. Patients with higher Hunt and Hess grades on admission developed significantly higher CRP serum levels. Patients with higher admission Fisher grades showed increased levels of CRP. A statistically significant inverse correlation was established in our series between CRP serum levels and GOS on discharge and CRP levels. Higher C-reactive protein serum levels are associated with worse clinical outcome and the occurrence of delayed ischemic neurological deficits. Because C-reactive protein levels were significantly elevated in the early phase, they might be a useful parameter to monitor.

Highlights

Cerebral vasospasm is a prolonged, sometimes severe narrowing of cerebral arteries following a subarachnoid hemorrhage (SAH), consisting the major cause of morbidity in this disease[1,2,3,4]
Higher C-reactive protein serum levels are associated with worse clinical outcome and the occurrence of delayed ischemic neurological deficits
Because C-reactive protein levels were significantly elevated in the early phase, they might be a useful parameter to monitor

Summary

Introduction

Cerebral vasospasm is a prolonged, sometimes severe narrowing of cerebral arteries following a subarachnoid hemorrhage (SAH), consisting the major cause of morbidity in this disease[1,2,3,4]. With a modern SAH management, the risk for death and permanent disability from vasospasm decrease for less than 10%, but it is still remains one of the leading causes of preventable poor outcome after rupture of an aneurysm[14,15,16]. Risk factors have been identified, including poor neurological grade or loss of consciousness on admission (HuntHess scale), clot subarachnoid volume (Fisher grade scale), cigarette smoking, preexisting hypertension, gender, patient age, aneurysm location, and inflammatory markers (interleukine-6, c reactive protein and leucocytes count)[17,18,19,20,21,22]

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