title: Serum and cerebrospinal fluid C-reactive protein levels as predictors of vasospasm in aneurysmal subarachnoid hemorrhage. Clinical article.
abstract: OBJECTIVE
  Cerebral vasospasm is a common and potentially devastating complication of aneurysmal subarachnoid hemorrhage (aSAH). Inflammatory processes seem to play a major role in the pathogenesis of vasospasm. The C-reactive protein (CRP) constitutes a highly sensitive inflammatory marker. The association of elevated systemic CRP and coronary vasospasm has been well established. Additionally, elevation of the serum CRP levels has been demonstrated in patients with aSAH. The purpose of the current study was to evaluate the possible relationship between elevated CRP levels in the serum and CSF and the development of vasospasm in patients with aSAH.
  
  
  METHODS
  A total of 41 adult patients in whom aSAH was diagnosed were included in the study. Their demographics, the admitting Glasgow Coma Scale (GCS) score, Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography studies, and daily neurological examinations were recorded. Serial serum and CSF CRP measurements were obtained on Days 0, 1, 2, 3, 5, 7, and 9. All patients underwent either surgical or endovascular treatment within 48 hours of their admission. The outcome was evaluated using the Glasgow Outcome Scale and the modified Rankin Scale.
  
  
  RESULTS
  The CRP levels in serum and CSF peaked on the 3rd postadmission day, and the CRP levels in CSF were always higher than the serum levels. Patients with lower admission GCS scores and higher Hunt and Hess and Fisher grades had statistically significantly higher levels of CRP in serum and CSF. Patients with angiographic vasospasm had higher CRP measurements in serum and CSF, in a statistically significant fashion (p < 0.0001). Additionally, patients with higher CRP levels in serum and CSF had less favorable outcome in this cohort.
  
  
  CONCLUSIONS
  Patients with aSAH who had high Hunt and Hess and Fisher grades and low GCS scores showed elevated CRP levels in their CSF and serum. Furthermore, patients developing angiographically proven vasospasm demonstrated significantly elevated CRP levels in serum and CSF, and increased CRP measurements were strongly associated with poor clinical outcome in this cohort.
authors.affiliation: Department of Neurosurgery, University Hospital of Larisa, School of Medicine, University of Thessaly, Larisa, Greece. fountas@med.uth.gr
authors.forename: Kostas N
authors.initials: KN
authors.lastname: Fountas
authors.forename: Anastasia
authors.initials: A
authors.lastname: Tasiou
authors.forename: Eftychia Z
authors.initials: EZ
authors.lastname: Kapsalaki
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Paterakis
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Grigorian
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Lee
authors.forename: Joe Sam
authors.initials: JS
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis / Q000097:blood / Q000134:cerebrospinal fluid; D002097:C-Reactive Protein / Q000032:analysis / Q000134:cerebrospinal fluid*; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000150:complications; D013346:Subarachnoid Space / Q000378:metabolism / Q000503:physiopathology; D016896:Treatment Outcome; D015854:Up-Regulation / Q000502:physiology; D020301:Vasospasm, Intracranial / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000209:etiology
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein