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Updated: Jun 3, 2026
Intrastriatal Injection of Autologous Blood or Clostridial Collagenase as Murine Models of Intracerebral Hemorrhage
Published on: July 3, 2014
C-reactive protein level measurement improves mortality prediction when added to the spontaneous intracerebral
Mario Di Napoli1, Daniel Agustin Godoy, Veronica Campi
1Neurological Service, San Camillo de’ Lellis General Hospital, Rieti, Italy. mariodinapoli@katamail.com
Insights
Elevated white blood cell count, C-reactive protein, and blood glucose levels predict increased mortality in spontaneous intracerebral hemorrhage (sICH) patients. C-reactive protein is the strongest independent predictor of death in sICH.
Area of Science:
- Neurology
- Critical Care Medicine
- Biomarkers
Background:
- Spontaneous intracerebral hemorrhage (sICH) is a severe neurological emergency.
- Hyperglycemia and inflammation are implicated in sICH-induced brain injury.
- Predictors of clinical outcome in sICH patients remain unclear.
Purpose of the Study:
- To investigate the prognostic value of white blood cell count (WBC), C-reactive protein (CRP), and blood glucose (BG) in sICH.
- To determine if these markers predict 30-day mortality and functional outcome in sICH patients.
Main Methods:
- Prospective evaluation of 210 sICH patients in intensive care units.
- Exclusion of patients with pre-existing inflammatory conditions.
- Measurement of WBC, CRP, and BG on admission; calculation of ICH scores.
- Assessment of 30-day mortality and Glasgow Outcome Scale for functional outcome.
Main Results:
- Higher WBC, CRP, and BG levels were associated with increased 30-day mortality on univariate analysis.
- Only CRP remained a significant independent predictor of mortality after adjusting for confounders.
- CRP improved mortality prediction when added to the established ICH score.
- No significant association was found between these markers and 30-day functional outcome.
Conclusions:
- Elevated WBC, CRP, and BG are associated with higher mortality in sICH.
- CRP is a key independent prognostic marker for mortality in sICH patients.
- These inflammatory and metabolic markers may not predict long-term functional recovery.
Background And Purpose:
Hyperglycemia and inflammation are involved in the progression of spontaneous intracerebral hemorrhage (sICH)-induced brain injury, but their role in predicting clinical outcome is not clear. We sought to determine whether elevation of white blood cell count (WBC), C-reactive protein (CRP), and blood glucose (BG) concentration at presentation prognosticate poor outcome in sICH patients.
Methods:
Between November 1, 2005 and October 31, 2009, 210 patients admitted to 2 intensive care units were prospectively consecutively evaluated after exclusion of patients with underlying inflammatory conditions. WBC, CRP, and BG were measured and ICH scores were calculated on first evaluation. Primary outcome was 30-day mortality. Secondary outcome was 30-day functional outcome using the Glasgow Outcome scale.
Results:
The median CRP concentration was 7.85 mg/L (interquartile range, 4.0-12.0 mg/L), median WBC count was 8.05×10(9)/L (interquartile range, 6.45-9.9×10(9)/L) and median glucose concentration was 7.66 mmol/L (interquartile range, 6.11-10.83 mmol/L). At 30 days, 63 patients (30%) were dead and 101 (48.1%) had poor outcome (Glasgow Outcome scale score, 1-3). Higher WBC (P<0.001), CRP (P<0.05), and BG (P<0.001) were associated with mortality on univariate analyses, but only CRP remained associated with mortality (P<0.005) after adjustment for multiple confounders. CRP improved mortality prediction when added to the ICH score. None of the markers tested had significant associations with functional outcome.
Conclusions:
Higher WBC, CRP, and BG are associated with increased mortality in sICH patients. Only CRP elevation portends higher risk of death independently of other indicators of sICH severity.
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