C-reactive protein and vasospasm after aneurysmal subarachnoid hemorrhage1

Romero, Flávio Ramalho; Catâneo, Daniele Cristina; Catâneo, Antônio José Maria

doi:10.1590/s0102-86502014000500009

Cited by 23 publications

(16 citation statements)

References 29 publications

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“…The actual time-from-ictus to baseline sampling ranged from <24 hours (day 0) to 96 hours (day 4) post ictus. This is in contrast to previous studies such as Juvela et al 20 where CRP values were obtained within 48 hours of ictus or Romero et al 19 where CRP values were obtained <24 hours post ictus. These time epochs explain the differences in absolute values of CRP recorded in the respective studies.…”

Section: Discussioncontrasting

confidence: 87%

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

et al. 2015

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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.ABBREVIATIONS:ALP, alkaline phosphataseALT, alanine aminotransferaseCK, creatine kinaseCRP, C-reactive proteinEVD, external ventricular drainageICH GCP, International Conference on Harmonisation guidelines for good clinical practicemRS, modified Rankin ScaleSAH, subarachnoid hemorrhageSTASH, Simvastatin in Aneurysmal Subarachnoid Hemorrhage TrialWBC, white blood cellsWFNS, World Federation of Neurological Surgeons

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Section: Discussioncontrasting

confidence: 87%

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

et al. 2015

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“…Similar to other studies, we found high mean CRP levels in the acute setting to be a predictor of poor long-term recovery after SAH. 28,29 By contrast, levels of TTR and their relationship to outcome after SAH have not been reported previously. TTR is often reported to be a biomarker of responsiveness to nutritional support; however, levels are influenced by inflammation and more accurately assess the impact of inflammation on the nutritional status.…”

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confidence: 85%

Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage

et al. 2015

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Objective: To analyze the impact of inflammation and negative nitrogen balance (NBAL) on nutritional status and outcomes after subarachnoid hemorrhage (SAH).Methods: This was a prospective observational study of SAH patients admitted between May 2008 and June 2012. Measurements of C-reactive protein (CRP), transthyretin (TTR), resting energy expenditure (REE), and NBAL (g/day) were performed over 4 preset time periods during the first 14 postbleed days (PBD) in addition to daily caloric intake. Factors associated with REE and NBAL were analyzed with multivariable linear regression. Hospital-acquired infections (HAI) were tracked daily for time-to-event analyses. Poor outcome at 3 months was defined as a modified Rankin Scale score $4 and assessed by multivariable logistic regression.Results: There were 229 patients with an average age of 55 6 15 years. Higher REE was associated with younger age (p 5 0.02), male sex (p , 0.001), higher Hunt Hess grade (p 5 0.001), and higher modified Fisher score (p 5 0.01). Negative NBAL was associated with lower caloric intake (p , 0.001), higher body mass index (p , 0.001), aneurysm clipping (p 5 0.03), and higher CRP:TTR ratio (p 5 0.03). HAIs developed in 53 (23%) patients on mean PBD 8 6 3. Older age (p 5 0.002), higher Hunt Hess (p , 0.001), lower caloric intake (p 5 0.001), and negative NBAL (p 5 0.04) predicted time to first HAI. Poor outcome at 3 months was associated with higher Hunt Hess grade (p , 0.001), older age (p , 0.001), negative NBAL (p 5 0.01), HAI (p 5 0.03), higher CRP:TTR ratio (p 5 0.04), higher body mass index (p 5 0.03), and delayed cerebral ischemia (p 5 0.04).Conclusions: Negative NBAL after SAH is influenced by inflammation and associated with an increased risk of HAI and poor outcome. Underfeeding and systemic inflammation are potential modifiable risk factors for negative NBAL and poor outcome after SAH. Neurology ® 2015;84:680-687 GLOSSARY CRP 5 C-reactive protein; DCI 5 delayed cerebral ischemia; HAI 5 hospital-acquired infection; ICU 5 intensive care unit; IDC 5 indirect calorimetry; mRS 5 modified Rankin Scale; NBAL 5 nitrogen balance; PBD 5 postbleed day; REE 5 resting energy expenditure; SAH 5 subarachnoid hemorrhage; SHOP 5 SAH outcomes project; TTR 5 transthyretin; UUN 5 urine urea nitrogen.Aneurysmal subarachnoid hemorrhage (SAH) is a significant contributor to all stroke-related potential years of life lost before age 65 years.1 Much of this is attributed to delayed cerebral ischemia (DCI).2 However, recent studies have found that both medical and infectious complications are significant independent contributors to morbidity and mortality after SAH.3-5 We previously found an association between poor nutritional status and infectious complications acutely after SAH. 6 Malnutrition has been associated with impaired immunologic function leading to increased rates of infection. 7 An assessment of nutritional profiles measured by indirect calorimetry (IDC) found SAH patients to have average resting energy expenditure (REE) rates ...

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“…At present, it is recognized that IL-6 is a kind of multi-functional glycoprotein cell inflammatory factor involved in various inflammatory reactions of central nervous system, which can cause immune response to the brain tissue damage and inflammation ( 15 ). CRP can be synthesized after IL-6 induction, thus activating the body's complement system and improving the immunity ( 16 , 17 ). Some scholars have pointed out that CRP can be associated with prognosis as a continuous variable ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of changes in IL-6, CRP and S100 in serum and NO in cerebrospinal fluid in subarachnoid hemorrhage and prognosis

Zhang

Sun

et al. 2018

Exp Ther Med

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Clinical significance of changes in interleukin-6 (IL-6), C-reactive protein (CRP) and S100 in serum and NO was investigated in cerebrospinal fluid (CSF) in subarachnoid hemorrhage (SAH) and its prognosis. A total of 43 SAH patients and 23 healthy subjects were selected and divided into cerebral vasospasm (CVS) group and non-CVS group, and favorable prognosis group and unfavorable prognosis group according to Hunt-Hess grade. The levels of IL-6, CRP, S100 and NO in CSF were detected, respectively, followed by statistical analysis of correlation. The higher the Hunt grade was, the higher the factor expression was; the expression levels of IL-6, CRP, S100 and NO in CSF were gradually increased in CVS group and unfavorable prognosis group, and the differences were significant compared with those in the control group. There was a positive correlation between the expression levels of each of the two factors among IL-6, CRP, S100 and NO in CSF, and the differences were statistically significant (P<0.05). The expression levels of IL-6, CRP, S100 and NO in CSF in SAH patients are significantly increased, showing positive correlations and participating in the occurrence and development of SAH, which provide new directions for the early clinical diagnosis of SAH.

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C-reactive protein and vasospasm after aneurysmal subarachnoid hemorrhage1

Cited by 23 publications

References 29 publications

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

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

Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage

Clinical significance of changes in IL-6, CRP and S100 in serum and NO in cerebrospinal fluid in subarachnoid hemorrhage and prognosis

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