TITLE:
Predicting vasospasm after aneurismal subarachnoid hemorrhage with C reactive protein levels
AUTHORS:
Flávio R. Romero, Luis G. Ducati, Marco A. Zanini, Daniele C. Cataneo, Antônio J. M. Cataneo, Roberto C. Gabarra
KEYWORDS:
Intracranial Vasospasm; Subarachnoid Hemorrhage; C Protein; Intracranial Aneurism
JOURNAL NAME:
Health,
Vol.5 No.7E,
July
18,
2013
ABSTRACT: Aim: The interest of
inflammatory marker increased in the last years, even in preventing clinical
outcome after subarachnoid hemorrhage (SAH). Our objective was to study the
relationships between C-reactive protein levels and clinical outcome and the
development of cerebral vasospasm after aneurismal SAH. Methods: One hundred
adult patients with aneurismal SAH were prospectively evaluated. Glasgow Coma
Scale (GCS) score, Hunt and Hess grade, Fisher grade, CT scans, digital
subtraction angiography studies, transcranial doppler (TCD) and daily
neurological examinations were recorded. Serial serum CRP measurements were
obtained on daily between admission and 10th
days. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS)
were used to predict outcome. Results: A progressive increase in the CRP levels from the admission to the 3rd postictal day was observed, followed by a slow decrease until the 9th day.
Hemodynamic changes in TCD were associated with higher serum CRP levels.
Patients with lower GCS scores presented with increased CRP levels. Patients
with higher Hunt and Hess grades on admission developed significantly higher
CRP serum levels. Patients with higher admission Fisher grades showed increased
levels of CRP. A statistically significant inverse correlation was established
in our series between CRP serum levels and GOS and mRS scores on discharge and
CRP levels. Conclusion: Increased CRP levels were strongly associated with
poor clinical outcome. CRP levels can predict cerebral vasospasm and delayed
ischemic deficits with higher statistic significance. There are relationships
between hemodynamic chances in TCD and higher CRP levels.