title: In-hospital C-reactive protein predicts outcome after aneurysmal subarachnoid haemorrhage treated by endovascular coiling.
abstract: BACKGROUND
  This study aimed to examine prospectively whether the inflammatory marker C-reactive protein (CRP) increases in patients with aneurysmal subarachnoid haemorrhage (aSAH) treated by endovascular coiling and investigate whether CRP could be used as prognostic factor for long-term neurological outcome.
  
  
  METHODS
  This single-hospital study comprised 98 consecutive patients with confirmed aSAH treated by endovascular coiling. Admission status was classified according to the World Federation of Neurosurgical Societies (WFNS) Scale and initial cerebral computed tomography according to Fisher scale. CRP was analysed on days 0, 1, 2, 3, 4, 6 and 8 after the initial bleed. A neurological follow up was performed 1 year later according to the Extended Glasgow Outcome Scale (GOSE) for overall outcome and National Institute of Health Stroke Scale (NIHSS) for focal deficit.
  
  
  RESULTS
  CRP values increased from normal to peak at 53 mg/l at day 3-4 and then declined, without normalising, at day 8. Patients with a higher increase in CRP had a poorer neurological outcome after 1 year. CRP during the first week had a stronger correlation to outcome (r = 0.417) and NIHSS (r = 0.449) than initial clinical status (WFNS; r = 0.280 and 0.274) and radiology (Fisher scale; r = 0.137 and 0.158). CRP increase indicated a risk of poor outcome (GOSE) (P < 0.001) and permanent loss of neurological function (NIHSS) (P < 0.001). Logistic regression analysis suggested that elevated CRP already on day 2 is an independent prognostic marker for outcome.
  
  
  CONCLUSIONS
  Early CRP values can perhaps be used as a prognostic factor for long-term neurological outcome prediction after endovascular treatment of aSAH.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Institution of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: L Z
authors.initials: LZ
authors.lastname: Csajbok
authors.forename: K
authors.initials: K
authors.lastname: Nylén
authors.forename: M
authors.initials: M
authors.lastname: Öst
authors.forename: H
authors.initials: H
authors.lastname: Sonander
authors.forename: B
authors.initials: B
authors.lastname: Nellgård
mesh_terms: D017542:Aneurysm, Ruptured / Q000097:blood / Q000150:complications*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D002532:Intracranial Aneurysm / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein