title: Predictive value of C-reactive protein for the outcome after primary intracerebral hemorrhage.
abstract: OBJECTIVE
  Primary intracerebral hemorrhage (ICH) carries high morbidity and mortality rates. Several factors have been suggested as predicting the outcome. The value of C-reactive protein (CRP) levels in predicting a poor outcome is unclear, and findings have been contradictory. In their population-based cohort, the authors tested whether, independent of confounding factors, elevated CRP levels on admission (< 24 hours after ictus) are associated with an unfavorable outcome.
  
  
  METHODS
  The authors identified all patients who suffered primary ICH between 1993 and 2008 among the population of Northern Ostrobothnia, Finland, and from the laboratory records they extracted the CRP values at admission. Independent predictors of an unfavorable outcome (moderate disability or worse according to the Glasgow Outcome Scale at 3 months) were tested by unconditional logistic regression in a model including all the well-established confounding factors and CRP on admission.
  
  
  RESULTS
  Of 961 patients, 807 (84%) had CRP values available within 24 hours of admission, and multivariable analysis showed elevated CRP at that point to be associated with an unfavorable outcome (OR 1.41 per 10 mg/L [95% CI 1.09-1.81], p < 0.01), together with diabetes mellitus (OR 1.99 [95% CI 1.09-3.64], p < 0.05), age (1.06 per year [95% CI 1.04-1.08], p < 0.001), low Glasgow Coma Scale score (0.75 per unit [95% CI 0.67-0.84], p < 0.001), hematoma size (1.05 per ml [95% CI 1.03-1.07], p < 0.001), and the presence of an intraventricular hemorrhage (2.70 [95% CI 1.66-4.38], p < 0.001). Subcortical location predicted a favorable outcome (0.33 [95% CI 0.20-0.54], p < 0.001).
  
  
  CONCLUSIONS
  Elevated CRP on admission is an independent predictor of an unfavorable outcome and is only slightly associated with the clinical and radiological severity of the bleeding.
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Pekka
authors.initials: P
authors.lastname: Löppönen
authors.forename: Cheng
authors.initials: C
authors.lastname: Qian
authors.forename: Sami
authors.initials: S
authors.lastname: Tetri
authors.forename: Seppo
authors.initials: S
authors.lastname: Juvela
authors.forename: Juha
authors.initials: J
authors.lastname: Huhtakangas
authors.forename: Michaela K
authors.initials: MK
authors.lastname: Bode
authors.forename: Matti
authors.initials: M
authors.lastname: Hillbom
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism*; D002423:Cause of Death; D002543:Cerebral Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D015986:Confounding Factors, Epidemiologic; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; CRP = C-reactive protein; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICH = intracerebral hemorrhage; IVH = intraventricular hemorrhage; intracerebral hemorrhage; outcome; predictive value; vascular disorders