Journal Article

Initial inflammatory response is an independent predictor of unfavorable outcome in patients with good-grade aneurysmal subarachnoid hemorrhage

Güresir, Erdem, Brandecker, Simon, Ilic, Inja, Kern, Tamara, Schuss, Patrick, Coch, Christoph, Fimmers, Rolf, Hadjiathanasiou, Alexis, Velten, Markus, Vatter, Hartmut, Güresir, Ági

2020

Overview

Purpose of the present study was to determine if routine biochemical markers of acute phase response are associated with unfavorable outcome in patients with good-grade aneurysmal SAH. 231 patients admitted with aneurysmal SAH and WFNS grade I - II were included in the present study. C-reactive protein (CRP) and procalcitonin (PCT) were measured within 24 h of admission. Outcome was assessed according to the modified Rankin Scale (mRS) after 6 months and stratified into favorable (mRS 0–2) vs. unfavorable (mRS 3–6). The multivariate regression analysis revealed “elevated baseline CRP” (p = .001, OR 3.2, 95% CI 1.6–6.6), “elevated baseline PCT” (p = .004, OR 26.0, 95% CI 2.9–235.5), “male gender” (p = .02, OR 2.3, 95% CI 1.1–4.8), and “age ≥ 65 years” (p = .009, OR 2.7, 95% CI 1.3–5.8) as a model for the prediction of unfavorable outcome in patients with good-grade SAH. An initial inflammatory response could be a possible explanation for poor outcome in good-grade SAH patients. These findings might help to identify a subgroup of good grade SAH patients who are at greater risk for unfavorable outcome early during treatment course/at baseline, and who could benefit most from potential anti-inflammatory therapy. •An initial inflammatory response in good-grade subarachnoid hemorrhage is an independent predictor of poor outcome.•Early anti-inflammatory treatment may improve outcome in good-grade subarachnoid hemorrhage.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Age Factors / Aged / Aneurysm, Ruptured - complications / Aneurysmal subarachnoid hemorrhage / Aneurysms / Biomarkers - blood / C-reactive protein / C-Reactive Protein - analysis / Critical care / Female / Good-grade / Hemorrhage / Humans / Inflammation / Inflammation - blood / Intracranial Aneurysm - complications / Laboratories / Licensed products / Male / Medical imaging / Middle Aged / Multivariate Analysis / Outcome / Patients / Procalcitonin / Procalcitonin - blood / Prognosis / Retrospective Studies / Risk Factors / ROC Curve / Stroke / Subarachnoid Hemorrhage - blood / Subarachnoid Hemorrhage - etiology / Subarachnoid Hemorrhage - therapy / Treatment Outcome