Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) Trial

Carole L Turner, Karol Budohoski, Christopher Smith, Peter J Hutchinson, Peter J Kirkpatrick, G D Murray, STASH Collaborators

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)786-793
Number of pages8
JournalNeurosurgery
Volume77
Issue number5
Early online date13 Aug 2015
DOIs
Publication statusPublished - Nov 2015

Keywords

  • Adult
  • Aged
  • Biomarkers
  • C-Reactive Protein
  • Female
  • Humans
  • Intracranial Aneurysm
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Simvastatin
  • Statistics as Topic
  • Subarachnoid Hemorrhage
  • Treatment Outcome
  • Clinical Trial
  • Journal Article
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Aneurysm
  • Inflammation

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