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Published on: July 3, 2014
Predictive value of C-reactive protein for the outcome after primary intracerebral hemorrhage
Pekka Löppönen1, Cheng Qian, Sami Tetri
1Departments of 1 Neurosurgery.
Insights
Elevated C-reactive protein (CRP) levels upon admission for intracerebral hemorrhage (ICH) independently predict a poor patient outcome. This finding holds true even when accounting for other known risk factors, suggesting CRP
Area of Science:
- Neurology
- Biomarkers
- Public Health
Background:
- Primary intracerebral hemorrhage (ICH) is associated with significant morbidity and mortality.
- Predictive factors for ICH outcomes are crucial for patient management.
- The role of C-reactive protein (CRP) in predicting ICH prognosis remains controversial.
Purpose of the Study:
- To investigate whether elevated C-reactive protein (CRP) levels on admission are independently associated with unfavorable outcomes in patients with primary intracerebral hemorrhage (ICH).
- To clarify the predictive value of early CRP levels in ICH prognosis.
Main Methods:
- A population-based cohort study identified patients with primary ICH between 1993 and 2008.
- C-reactive protein (CRP) values at admission (within 24 hours) were extracted from laboratory records.
- Unconditional logistic regression was used to identify independent predictors of unfavorable outcome (moderate disability or worse at 3 months), adjusting for confounding factors.
Main Results:
- Of 961 patients, 807 had CRP values available within 24 hours.
- Elevated CRP on admission was significantly associated with an unfavorable outcome (OR 1.41 per 10 mg/L, p < 0.01).
- Other independent predictors of poor outcome included diabetes mellitus, older age, lower Glasgow Coma Scale score, larger hematoma size, and intraventricular hemorrhage. Subcortical location predicted a favorable outcome.
Conclusions:
- Elevated C-reactive protein (CRP) levels upon hospital admission are an independent predictor of unfavorable outcomes in primary intracerebral hemorrhage (ICH).
- The association between CRP and outcome is only minimally influenced by the clinical and radiological severity of the hemorrhage.
Object:
Primary intracerebral hemorrhage (ICH) carries high morbidity and mortality rates. Several factors have been suggested as predicting the outcome. The value of C-reactive protein (CRP) levels in predicting a poor outcome is unclear, and findings have been contradictory. In their population-based cohort, the authors tested whether, independent of confounding factors, elevated CRP levels on admission (< 24 hours after ictus) are associated with an unfavorable outcome.
Methods:
The authors identified all patients who suffered primary ICH between 1993 and 2008 among the population of Northern Ostrobothnia, Finland, and from the laboratory records they extracted the CRP values at admission. Independent predictors of an unfavorable outcome (moderate disability or worse according to the Glasgow Outcome Scale at 3 months) were tested by unconditional logistic regression in a model including all the well-established confounding factors and CRP on admission.
Results:
Of 961 patients, 807 (84%) had CRP values available within 24 hours of admission, and multivariable analysis showed elevated CRP at that point to be associated with an unfavorable outcome (OR 1.41 per 10 mg/L [95% CI 1.09-1.81], p < 0.01), together with diabetes mellitus (OR 1.99 [95% CI 1.09-3.64], p < 0.05), age (1.06 per year [95% CI 1.04-1.08], p < 0.001), low Glasgow Coma Scale score (0.75 per unit [95% CI 0.67-0.84], p < 0.001), hematoma size (1.05 per ml [95% CI 1.03-1.07], p < 0.001), and the presence of an intraventricular hemorrhage (2.70 [95% CI 1.66-4.38], p < 0.001). Subcortical location predicted a favorable outcome (0.33 [95% CI 0.20-0.54], p < 0.001).
Conclusions:
Elevated CRP on admission is an independent predictor of an unfavorable outcome and is only slightly associated with the clinical and radiological severity of the bleeding.
