Csajbok L Z, Nylén K, Öst M, Sonander H, Nellgård B
Department of Anaesthesiology and Intensive Care, Institution of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Acta Anaesthesiol Scand. 2015 Feb;59(2):255-64. doi: 10.1111/aas.12441.
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.
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.
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.
Early CRP values can perhaps be used as a prognostic factor for long-term neurological outcome prediction after endovascular treatment of aSAH.
本研究旨在前瞻性地检测经血管内栓塞治疗的动脉瘤性蛛网膜下腔出血(aSAH)患者的炎症标志物C反应蛋白(CRP)是否升高,并探究CRP能否作为长期神经功能预后的预测因素。
这项单中心研究纳入了98例经血管内栓塞治疗确诊为aSAH的连续患者。入院状态根据世界神经外科联合会(WFNS)分级进行分类,初始头颅计算机断层扫描根据Fisher分级进行评估。在首次出血后的第0、1、2、3、4、6和8天分析CRP水平。1年后根据扩展格拉斯哥预后量表(GOSE)评估总体预后,根据美国国立卫生研究院卒中量表(NIHSS)评估局灶性神经功能缺损。
CRP值从正常水平升高至第3 - 4天的峰值53mg/l,然后下降,至第8天未恢复正常。CRP升高幅度较大的患者1年后神经功能预后较差。与初始临床状态(WFNS;r = 0.280和0.274)及影像学表现(Fisher分级;r = 0.137和0.158)相比,第1周的CRP水平与预后(r = 0.417)及NIHSS(r = 0.449)的相关性更强。CRP升高提示预后不良(GOSE)风险(P < 0.001)及神经功能永久性丧失(NIHSS)风险(P < 0.001)。逻辑回归分析表明,第2天CRP升高即为预后的独立预测指标。
早期CRP值或许可作为aSAH血管内治疗后长期神经功能预后预测的一个预测因素。