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Subdural and Systemic C-Reactive Protein in Patients with Chronic Subdural Hematoma Recurrence
Jonathan Truels Hansen1, Thomas Svinning Valeur Tursø1,2, Markus Harboe Olsen3,4
1Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Background:
C-reactive protein (CRP) level in blood is a standard marker for systemic inflammation. Inflammation is central in chronic subdural hematoma (CSDH) pathophysiology, and inflammatory biomarkers may hold clinical potential in assessing the level of inflammation induced by a CSDH. This study explores the role of CRP in patients with CSDH by (1) measuring systemic and subdural CRP levels, (2) investigating CRP as a potential predictor for recurrent CSDH and (3) comparing CRP levels between the first and second operations in patients with CSDH recurrence.
Methods:
CRP levels were measured both in systemic blood and subdural fluid from adult CSDH patients. Recurrence rate and mortality within 90 days were recorded. In total, 111 patients were included, of whom 25 were operated on for CSDH recurrence.
Results:
Systemic CRP levels (2.54 mg/L (1.40-9.75)) were higher than subdural levels (2.09 mg/L [0.99-5.22]) (p < 0.0001) but within the clinically defined normal CRP range of < 3 mg/L. Neither systemic nor subdural CRP levels could predict recurrence. Both systemic and subdural CRP levels in recurrent CSDH patients were higher at the time of the second surgery compared to the first surgery (p systemic = 0.004 and p subdural < 0.0001).
Conclusion:
This is the first study to establish a correlation between systemic and subdural CRP levels in CSDH patients. The increased levels of CRP at the time of the second surgery may demonstrate a constantly evolving inflammatory process toward the development of a recurrence.
