C-Reactive Protein Predicts Hematoma Growth in Intracerebral Hemorrhage

Abstract

Inflammation is a major feature of sICH pathology, [3][4][5] and inflammatory markers on admission, such as fever, elevated white blood cell (WBC) count, interleukin-6 (IL-6), and fibrinogen are associated with worse short-term outcomes. 3,5,6 C-reactive protein (CRP), an acute-phase reactant induced by IL-6, is associated with 30-day mortality in ICH patients, 7 but its relationship with EHG is unknown. Our primary goal was to determine the link between CRP and EHG after sICH. As a secondary objective, we also sought to establish the relationship between CRP and early neurological worsening (ENW).Background and Purpose-Early hematoma growth (EHG) occurs in about one third of patients with spontaneous intracerebral hemorrhage. The main aim of this study was to investigate the potential of plasma C-reactive protein (CRP) for predicting EHG after acute spontaneous intracerebral hemorrhage. Methods-Plasma CRP was measured within 6 hours of onset (median, 120 minutes) in 399 patients with primary or vitamin K antagonist-associated spontaneous intracerebral hemorrhage and without recent infection. Computed tomography brain scans were performed at baseline and repeated within 24 hours (median, 22 hours). The primary outcome was EHG, defined as absolute growth >12.5 cm 3 or relative growth >33%. Secondary outcomes included early neurological worsening (ENW) using the Glasgow Coma Scale and 30-day mortality. Multivariable regression analyses were used to evaluate associations of CRP concentration and outcomes. Kaplan-Meier analysis was used for survival. Key Words: C-reactive protein ◼ cerebral hemorrhage ◼ inflammation ◼ prognosis Results-EHG C-Reactive Protein Predicts Hematoma Growth in Intracerebral HemorrhageMario

Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data

“…We screened 4191 studies identified by our searches, assessed 167 for eligibility, invited 77 eligible cohorts to share data, and obtained patient-level data from 36 (47%) cohorts18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51 involving 6428 patients with repeat brain imaging after intracerebral haemorrhage between 1985 and 2015 (no data up to 1984 were obtained; figure 1; appendix). 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55 Countries classified as high income by the World Bank contributed to 26 (72%) of 36 collaborating cohorts versus 30 (73%) of 41 eligible cohorts that did not collaborate.…”

C-reactive protein enhances IgG-mediated phagocyte responses and thrombocytopenia

“…57 In addition, peptic ulcers have been reported to upregulate IL-6, 58 with a subsequent rise is CRP levels, which in turn may predict gastrointestinal bleeding events.…”

“…56 CRP levels were even found to predict early hematoma outgrowth after ICH. 57 In addition, peptic ulcers have been reported to upregulate IL-6, 58 with a subsequent rise is CRP levels, which in turn may predict gastrointestinal bleeding events. [59][60][61] Additionally, we previously found that anti-HPA-1a antibodies can reduce endothelial cell spreading and monolayer integrity, possibly affecting bleeding tendency.…”

Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage

“…Patient registration years ranged from 1993 to 2014, with 90% of patients from 2004 to 2013. Registry methods are summarized in Supplementary Table I, with further details previously published 2, 3, 4, 14, 15, 16, 17, 18, 19, 20…”