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Clinical Trial
. 2015 Nov;77(5):786-92; discussion 792-3.
doi: 10.1227/NEU.0000000000000963.

Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) Trial

Carole L Turner  1 , Karol Budohoski, Christopher Smith, Peter J Hutchinson, Peter J Kirkpatrick, G D Murray; STASH collaborators
Collaborators, Affiliations
Clinical Trial

Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) Trial

Carole L Turner et al. Neurosurgery. 2015 Nov.

Erratum in

Abstract

Background: There remains a proportion of patients with unfavorable outcomes after aneurysmal subarachnoid hemorrhage, of particular relevance in those who present with a good clinical grade. A forewarning of those at risk provides an opportunity towards more intensive monitoring, investigation, and prophylactic treatment prior to the clinical manifestation of advancing cerebral injury.

Objective: To assess whether biochemical markers sampled in the first days after the initial hemorrhage can predict poor outcome.

Methods: All patients recruited to the multicenter Simvastatin in Aneurysmal Hemorrhage Trial (STASH) were included. Baseline biochemical profiles were taken between time of ictus and day 4 post ictus. The t-test compared outcomes, and a backwards stepwise binary logistic regression was used to determine the factors providing independent prediction of an unfavorable outcome.

Results: Baseline biochemical data were obtained in approximately 91% of cases from 803 patients. On admission, 73% of patients were good grade (World Federation of Neurological Surgeons grades 1 or 2); however, 84% had a Fisher grade 3 or 4 on computed tomographic scan. For patients presenting with good grade on admission, higher levels of C-reactive protein, glucose, and white blood cells and lower levels of hematocrit, albumin, and hemoglobin were associated with poor outcome at discharge. C-reactive protein was found to be an independent predictor of outcome for patients presenting in good grade.

Conclusion: Early recording of C-reactive protein may prove useful in detecting those good grade patients who are at greater risk of clinical deterioration and poor outcome.

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Figures

FIGURE
FIGURE
Receiver operating characteristic curves for baseline C-reactive protein values. Good grade patients on admission and poor outcome at discharge. AUC, area under the curve.
See this image and copyright information in PMC

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