Artikel
Inflammatory response at admission is an independent predictor of unfavourable outcome in good-grade aneurysmal subarachnoid haemorrhage patients
Eine initiale Entzündungsreaktion bei Patienten mit niedrigradiger aneurysmatischer Subarachnoidalblutung ist ein unabhängiger Prädiktor für ein schlechtes neurologisches Outcome
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Veröffentlicht: | 26. Juni 2020 |
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Objective: Patients with good-grade aneurysmal subarachnoid hemorrhage (SAH) are considered to have a favorable neurological outcome. However, a small but significant number of such patients might only achieve unfavorable outcome. Therefore, the purpose of the present study was to determine if routine biochemical markers of acute phase response are associated with unfavorable outcome in patients with good-grade aneurysmal SAH.
Methods: 231 patients with aneurysmal SAH and a World Federation of Neurosurgical Societies (WFNS) grade I and II were included in the present study. C-reactive protein (CRP) and procalcitonin (PCT) were measured within 24h of admission as part of routine laboratory workup. Outcome was assessed according to the modified Rankin Scale (mRS) after 6 months and stratified into favorable (mRS 0-2) vs. unfavorable (mRS 3-6).
Results: The multivariate regression analysis revealed "elevated baseline CRP" (p=0.02, OR 2.6, 95% CI 1.2-5.5), "elevated baseline PCT" (p=0.004, OR 29.5, 95% CI 3.0-287.9), "presence of CVS" (p=0.01, OR 3.0, 95% CI 1.3-6.9), "age > 65 years" (p=0.009, OR 2.9, 95% CI 1.3-6.5), and "development of DCI" (p=0.001, OR 5.9, 95% CI 2.0-17.7) as a model for the prediction of unfavorable outcome in patients with good-grade SAH.
Conclusion: Several independent factors, easy to measure, at the time of admission were found to be associated with unfavorable outcome in patients with good-grade aneurysmal SAH in the present study. An initial inflammatory response might be one explanation for poor outcome in good-grade patients. These findings might help to identify a subgroup of good grade SAH patients who are at greater risk for unfavorable outcome early during treatment course.