The highest C-reactive protein (OR 1.003) and neutrophil-to-lymphocyte ratio (OR 1.025) values in the first 7 days after aneurysmal subarachnoid hemorrhage were independently associated with unfavorable neurological outcomes at 3 months.
Cohort (n=547)
No
Do elevated systemic inflammation biomarkers (CRP and NLr) predict unfavorable neurological outcomes and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage?
Elevated systemic inflammation biomarkers, particularly CRP, in the first 7 days after aneurysmal subarachnoid hemorrhage are independently associated with unfavorable neurological outcomes at 3 months.
Effect estimate: OR 1.003 (95% CI 1.001-1.005)
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating condition that is associated with cerebral and systemic inflammation. C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLr) are easily available biomarkers of systemic inflammation. Therefore, we aimed to assess the impact of elevated CRP and NLr on aSAH outcomes. This retrospective, single-center study included adult patients admitted with aSAH to the intensive care unit (ICU) from January 2007 to December 2023. We recorded serum CRP and NLr levels during the first 7 days of ICU stay. An unfavorable neurological outcome at 3 months was defined as a Glasgow Outcome Scale (GOS) score of 1–3. A total of 547 patients were included in the study; 250 (45.7%) experienced unfavorable outcomes (UOs), and 140 (25.6%) developed delayed cerebral ischemia (DCI). Patients with unfavorable outcomes had higher levels of CRP from days 2 to 7 after SAH ( p = 0.001) and higher NLr ( p = 0.06) than those with favorable outcomes (FOs). In a multivariate logistic regression model, the highest CRP value (OR: 1.003, 95% CI: 1.001–1.005) and the highest NLr value (OR: 1.025; 95% CI: 1.001–1.050) in the first 7 days after SAH were independently associated with the occurrence of unfavorable outcomes. The highest NLr value was also associated with the development of DCI (sHR: 1.02, 95% CI: 1.01–1.03). In conclusion, high CRP and NLr values have a significant prognostic role in aSAH patients, reinforcing the importance of inflammation as a potential mechanism of secondary brain injury.
Giovampaola et al. (Tue,) conducted a cohort in Aneurysmal subarachnoid hemorrhage (aSAH) (n=547). Elevated systemic inflammation biomarkers (CRP and NLr) vs. Lower levels of systemic inflammation biomarkers was evaluated on Unfavorable neurological outcome at 3 months (Glasgow Outcome Scale score of 1-3) (OR 1.003, 95% CI 1.001-1.005). The highest C-reactive protein (OR 1.003) and neutrophil-to-lymphocyte ratio (OR 1.025) values in the first 7 days after aneurysmal subarachnoid hemorrhage were independently associated with unfavorable neurological outcomes at 3 months.