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 language | English |
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Pages (from-to) | 786-793 |
Number of pages | 8 |
Journal | Neurosurgery |
Volume | 77 |
Issue number | 5 |
Early online date | 13 Aug 2015 |
DOIs | |
Publication status | Published - 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