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Elevated C-reactive protein and white blood cell count at admission predict functional outcome after non-aneurysmal subarachnoid hemorrhage

  • Patrick Schuss
  • Alexis Hadjiathanasiou
  • Simon Brandecker
  • Ági Güresir
  • Hartmut Vatter
  • Erdem Güresir
Original Communication
  • 29 Downloads

Abstract

Introduction

Patients with non-aneurysmal subarachnoid hemorrhage (SAH) are considered to have an overall benign course of disease compared to patients suffering from aneurysmal SAH. Nevertheless, 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 laboratory markers of acute phase response are associated with unfavorable outcome in patients with non-aneurysmal SAH.

Methods

From 2006 to 2017, 154 patients suffering from non-aneurysmal SAH were admitted to our institution. Patients were stratified according to the distribution of cisternal blood into patients with perimesencephalic SAH (pSAH) versus non-perimesencephalic SAH (npSAH). C-reactive protein (CRP) and white blood cells (WBC) assessments were performed within 24 h 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 “CRP > 5 mg/l” (p = 0.004, OR 143.7), “WBC count > 12.1 G/l” (p = 0.006, OR 47.8), “presence of IVH” (p = 0.02, OR 13.5), “poor-grade SAH” (p = 0.01, OR 45.2) and “presence of CVS” (p = 0.003, OR 149.9) as independently associated with unfavorable outcome in patients with non-aneurysmal SAH.

Conclusion

Elevated C-reactive protein and WBC count at admission were associated with unfavorable outcome after non-aneurysmal SAH.

Keywords

Non-aneurysmal subarachnoid hemorrhage Outcome Perimesencephalic C-reactive protein 

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The present study was approved by the local ethics committee.

Informed consent

Informed consent was not sought as a retrospective study design was used.

References

  1. 1.
    Rinkel GJ, Wijdicks EF, Vermeulen M, Hasan D, Brouwers PJ, van Gijn J (1991) The clinical course of perimesencephalic nonaneurysmal subarachnoid hemorrhage. Ann Neurol 29(5):463–468CrossRefGoogle Scholar
  2. 2.
    van Gijn J, van Dongen KJ, Vermeulen M, Hijdra A (1985) Perimesencephalic hemorrhage: A nonaneurysmal and benign form of subarachnoid hemorrhage. Neurology 35(4):493–497CrossRefGoogle Scholar
  3. 3.
    Schuss P, Hadjiathanasiou A, Brandecker S, Wispel C, Borger V, Güresir Á, Vatter H, Güresir E (2018) Risk factors for shunt dependency in patients suffering from spontaneous, non-aneurysmal subarachnoid hemorrhage. Neurosurg Rev.  https://doi.org/10.1007/s10143-018-0970-0. CrossRefPubMedGoogle Scholar
  4. 4.
    Rinkel GJ, Wijdicks EF, Hasan D, Kienstra GE, Franke CL, Hageman LM, Vermeulen M, van Gijn J (1991) Outcome in patients with subarachnoid haemorrhage and negative angiography according to pattern of haemorrhage on computed tomography. Lancet 338(8773):964–968CrossRefGoogle Scholar
  5. 5.
    Elhadi AM, Zabramski JM, Almefty KK, Mendes GA, Nakaji P, McDougall CG, Albuquerque FC, Preul MC, Spetzler RF (2015) Spontaneous subarachnoid hemorrhage of unknown origin: Hospital course and long-term clinical and angiographic follow-up. J Neurosurg 122(3):663–670CrossRefGoogle Scholar
  6. 6.
    Konczalla J, Schmitz J, Kashefiolasl S, Senft C, Platz J, Seifert V (2016) Non-aneurysmal non-perimesencephalic subarachnoid hemorrhage: effect of rehabilitation at short-term and in a prospective study of long-term follow-up. Top Stroke Rehabil 23(4):261–268CrossRefGoogle Scholar
  7. 7.
    Konczalla J, Kashefiolasl S, Brawanski N, Lescher S, Senft C, Platz J, Seifert V (2016) Cerebral vasospasm and delayed cerebral infarctions in 225 patients with non-aneurysmal subarachnoid hemorrhage: the underestimated risk of fisher 3 blood distribution. J Neurointerventional Surg 8(12):1247–1252CrossRefGoogle Scholar
  8. 8.
    Gupta SK, Gupta R, Khosla VK, Mohindra S, Chhabra R, Khandelwal N, Gupta V, Mukherjee KK, Tewari MK, Pathak A, Mathuriya SN (2009) Nonaneurysmal nonperimesencephalic subarachnoid hemorrhage: is it a benign entity? Surg Neurol 71(5):566–571; (discussion 571,571–562,572)CrossRefGoogle Scholar
  9. 9.
    Al-Mufti F, Merkler AE, Boehme AK, Dancour E, May T, Schmidt JM, Park S, Connolly ES, Lavine SD, Meyers PM, Claassen J, Agarwal S (2018) Functional outcomes and delayed cerebral ischemia following nonperimesencephalic angiogram-negative subarachnoid hemorrhage similar to aneurysmal subarachnoid hemorrhage. Neurosurgery 82(3):359–364CrossRefGoogle Scholar
  10. 10.
    Juvela S, Kuhmonen J, Siironen J (2012) C-reactive protein as predictor for poor outcome after aneurysmal subarachnoid haemorrhage. Acta Neurochir 154(3):397–404CrossRefGoogle Scholar
  11. 11.
    Al-Mufti F, Misiolek KA, Roh D, Alawi A, Bauerschmidt A, Park S, Agarwal S, Meyers PM, Connolly ES, Claassen J, Schmidt JM (2018) White blood cell count improves prediction of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage. Neurosurgery.  https://doi.org/10.1093/neuros/nyy045 CrossRefPubMedGoogle Scholar
  12. 12.
    Rosen DS, Macdonald RL (2004) Grading of subarachnoid hemorrhage: modification of the world world federation of neurosurgical societies scale on the basis of data for a large series of patients. Neurosurgery 54(3):566–575 (discussion 575–566)CrossRefGoogle Scholar
  13. 13.
    Teasdale GM, Drake CG, Hunt W, Kassell N, Sano K, Pertuiset B, De Villiers JC (1988) A universal subarachnoid hemorrhage scale: report of a committee of the world federation of neurosurgical societies. J Neurol Neurosurg Psychiatry 51(11):1457CrossRefGoogle Scholar
  14. 14.
    Schuss P, Wispel C, Borger V, Güresir Á, Vatter H, Güresir E (2018) Accuracy and safety of ventriculostomy using two different procedures of external ventricular drainage: a single-center series. J Neurol Surg Part A Central Eur Neurosurg 79(3):206–210CrossRefGoogle Scholar
  15. 15.
    Raabe A, Beck J, Keller M, Vatter H, Zimmermann M, Seifert V (2005) Relative importance of hypertension compared with hypervolemia for increasing cerebral oxygenation in patients with cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 103(6):974–981CrossRefGoogle Scholar
  16. 16.
    Boswell S, Thorell W, Gogela S, Lyden E, Surdell D (2013) Angiogram-negative subarachnoid hemorrhage: outcomes data and review of the literature. J Stroke Cerebrovasc Dis 22(6):750–757CrossRefGoogle Scholar
  17. 17.
    Konczalla J, Schuss P, Platz J, Vatter H, Seifert V, Güresir E (2015) Clinical outcome and prognostic factors of patients with angiogram-negative and non-perimesencephalic subarachnoid hemorrhage: benign prognosis like perimesencephalic sah or same risk as aneurysmal sah? Neurosurg Rev 38(1):121–127 (discussion 127) CrossRefGoogle Scholar
  18. 18.
    Jabbarli R, Reinhard M, Roelz R, Shah M, Niesen WD, Kaier K, Taschner C, Weyerbrock A, Van Velthoven V (2015) Outcome prediction after non-aneurysmal non-traumatic subarachnoid hemorrhage. Curr Neurovasc Res 12(3):269–276CrossRefGoogle Scholar
  19. 19.
    McGirt MJ, Mavropoulos JC, McGirt LY, Alexander MJ, Friedman AH, Laskowitz DT, Lynch JR (2003) Leukocytosis as an independent risk factor for cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg 98(6):1222–1226CrossRefGoogle Scholar
  20. 20.
    Rothoerl RD, Axmann C, Pina AL, Woertgen C, Brawanski A (2006) Possible role of the c-reactive protein and white blood cell count in the pathogenesis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg Anesthesiol 18(1):68–72CrossRefGoogle Scholar
  21. 21.
    Dhar R, Diringer MN (2008) The burden of the systemic inflammatory response predicts vasospasm and outcome after subarachnoid hemorrhage. Neurocritical Care 8(3):404–412CrossRefGoogle Scholar
  22. 22.
    Tam AK, Ilodigwe D, Mocco J, Mayer S, Kassell N, Ruefenacht D, Schmiedek P, Weidauer S, Pasqualin A, Macdonald RL (2010) Impact of systemic inflammatory response syndrome on vasospasm, cerebral infarction, and outcome after subarachnoid hemorrhage: Exploratory analysis of conscious-1 database. Neurocritical Care 13(2):182–189CrossRefGoogle Scholar
  23. 23.
    Muroi C, Bellut D, Coluccia D, Mink S, Fujioka M, Keller E (2011) Systemic interleukin-6 concentrations in patients with perimesencephalic non-aneurysmal subarachnoid hemorrhage. J Clin Neurosci 18(12):1626–1629CrossRefGoogle Scholar
  24. 24.
    Frontera JA, Provencio JJ, Sehba FA, McIntyre TM, Nowacki AS, Gordon E, Weimer JM, Aledort L (2017) The role of platelet activation and inflammation in early brain injury following subarachnoid hemorrhage. Neurocritical Care 26(1):48–57CrossRefGoogle Scholar
  25. 25.
    Turner CL, Budohoski K, Smith C, Hutchinson PJ, Kirkpatrick PJ, Murray GD, collaborators S (2015) Elevated baseline c-reactive protein as a predictor of outcome after aneurysmal subarachnoid hemorrhage: data from the simvastatin in aneurysmal subarachnoid hemorrhage (STASH) trial. Neurosurgery 77(5):786–792; (discussion 792–783) CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Patrick Schuss
    • 1
  • Alexis Hadjiathanasiou
    • 1
  • Simon Brandecker
    • 1
  • Ági Güresir
    • 1
  • Hartmut Vatter
    • 1
  • Erdem Güresir
    • 1
  1. 1.Department of NeurosurgeryRheinische Friedrich-Wilhelms-University BonnBonnGermany

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