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Clinical usefulness of early serial measurements of C-reactive protein as outcome predictors in patients with subarachnoid hemorrhage.
BMC Neurology ( IF 2.2 ) Pub Date : 2020-03-27 , DOI: 10.1186/s12883-020-01687-3
Sangkil Lee 1 , Yong Oh Kim 2 , Jeong-Am Ryu 2, 3
Affiliation  

The purpose of this study was to evaluate the role of C-reactive protein (CRP) in predicting neurological outcomes of patients with subarachnoid hemorrhage (SAH). In this retrospective, observational study of adult patients with SAH treated between January 2012 and June 2017. Initial CRP levels collected within 24 h from the onset of SAH, the follow-up CRP levels were measured. The primary outcome was neurological status at six-month follow-up assessed with the Glasgow Outcome Scale (GOS, 1 to 5). Among 156 patients with SAH, 145 (92.9%) survived until discharge. Of these survivors, 109 (69.9%) manifested favorable neurological outcomes (GOS of 4 or 5). Initial CRP levels on admission and maximal CRP levels within four days were significantly higher in the group with poor neurological outcome compared with those manifesting favorable neurological outcomes (P = 0.022, P < 0.001, respectively). However, the clearance of CRPs did not differ significantly between the two groups (P = 0.785). Analysis of the receiver operating characteristic curve for prediction of poor neurological outcome showed that the performance of the maximal CRP was significantly better compared with the initial CRP or the clearance of CRP (P = 0.007, P < 0.001, respectively). In this study, the effect of CRP on neurological outcomes differed according to surgical clipping. The maximal CRP levels within four days facilitate the prediction of neurological outcomes of SAH patients without surgical clipping (C-statistic: 0.856, 95% confidence interval [CI]: 0.767–0.921). However, they were poorly associated with neurological prognoses in SAH patients who underwent surgical clipping (C-statistic: 0.562, 95% CI: 0.399–0.716). Multivariable logistic regression analysis revealed that age (adjusted odds ratio [OR]: 1.10, 95% CI: 1.052–1.158), initial Glasgow Coma Scale (adjusted OR: 0.74, 95% CI: 0.647–0.837), and maximal CRP without surgical clipping (adjusted OR: 1.27, 95% CI: 1.066–1.516) were significantly associated with poor neurological outcomes in SAH patients. Early serial measurements of CRP may be used to predict neurological outcomes of SAH patients. Furthermore, maximal CRP levels within four days post-SAH are significantly correlated with poor neurological outcomes.

中文翻译:

早期连续测定C反应蛋白作为蛛网膜下腔出血患者预后指标的临床价值。

这项研究的目的是评估C反应蛋白(CRP)在预测蛛网膜下腔出血(SAH)患者神经系统预后中的作用。在这项回顾性观察研究中,对2012年1月至2017年6月间接受治疗的SAH成年患者进行了研究。从SAH发作开始的24小时内收集了初始CRP水平,并随访了CRP水平。主要结果是通过格拉斯哥成果量表(GOS,1至5)评估的六个月随访中的神经系统状况。在156例SAH患者中,有145例(92.9%)存活至出院。在这些幸存者中,有109名(69.9%)表现出良好的神经学预后(GOS为4或5)。与表现出良好神经学预后的组相比,神经学预后不良的组在入院时的初始CRP水平和四天内的最大CRP水平显着更高(分别为P = 0.022,P <0.001)。但是,两组之间的CRP清除率没有显着差异(P = 0.785)。通过对接收器工作特性曲线的分析来预测不良的神经学预后,发现与初始CRP或CRP清除率相比,最大CRP的性能明显更好(分别为P = 0.007,P <0.001)。在这项研究中,CRP对神经系统结果的影响因手术剪裁而异。四天之内的最高CRP水平有助于预测SAH患者的神经系统结局,而无需进行手术限制(C统计量:0。856,95%置信区间[CI]:0.767-0.921)。然而,它们与接受外科手术钳扎的SAH患者的神经系统预后关系不佳(C统计:0.562,95%CI:0.399–0.716)。多变量logistic回归分析显示年龄(校正比值比[OR]:1.10,95%CI:1.052–1.158),初始格拉斯哥昏迷量表(校正OR:0.74,95%CI:0.647–0.837)和最大CRP(无手术)截断(校正后的OR:1.27,95%CI:1.066–1.516)与SAH患者的神经系统不良预后显着相关。CRP的早期连续测量可用于预测SAH患者的神经系统结果。此外,SAH后四天内的最高CRP水平与不良的神经学预后显着相关。它们与接受手术钳夹的SAH患者的神经系统预后关系不佳(C统计:0.562,95%CI:0.399–0.716)。多变量logistic回归分析显示年龄(校正比值比[OR]:1.10,95%CI:1.052–1.158),初始格拉斯哥昏迷量表(校正OR:0.74,95%CI:0.647–0.837)和最大CRP(无手术)截断(校正后的OR:1.27,95%CI:1.066–1.516)与SAH患者的神经系统不良预后显着相关。CRP的早期连续测量可用于预测SAH患者的神经系统结果。此外,SAH后四天内的最高CRP水平与不良的神经学预后显着相关。它们与接受手术钳夹的SAH患者的神经系统预后关系不佳(C统计:0.562,95%CI:0.399–0.716)。多变量logistic回归分析显示年龄(校正比值比[OR]:1.10,95%CI:1.052–1.158),初始格拉斯哥昏迷量表(校正OR:0.74,95%CI:0.647–0.837)和最大CRP(无手术)截断(校正后的OR:1.27,95%CI:1.066–1.516)与SAH患者的神经系统不良预后显着相关。CRP的早期连续测量可用于预测SAH患者的神经系统结果。此外,SAH后四天内的最高CRP水平与不良的神经学预后显着相关。多变量logistic回归分析显示年龄(校正比值比[OR]:1.10,95%CI:1.052–1.158),初始格拉斯哥昏迷量表(校正OR:0.74,95%CI:0.647–0.837)和最大CRP(无手术)截断(校正后的OR:1.27,95%CI:1.066–1.516)与SAH患者的神经系统不良预后显着相关。CRP的早期连续测量可用于预测SAH患者的神经系统结果。此外,SAH后四天内的最高CRP水平与不良的神经学预后显着相关。多变量logistic回归分析显示年龄(校正比值比[OR]:1.10,95%CI:1.052–1.158),初始格拉斯哥昏迷量表(校正OR:0.74,95%CI:0.647–0.837)和最大CRP(无手术)截断(校正后的OR:1.27,95%CI:1.066–1.516)与SAH患者的神经系统不良预后显着相关。CRP的早期连续测量可用于预测SAH患者的神经系统结果。此外,SAH后四天内的最高CRP水平与不良的神经学预后显着相关。516)与SAH患者的神经系统不良结局显着相关。CRP的早期连续测量可用于预测SAH患者的神经系统结果。此外,SAH后四天内的最高CRP水平与不良的神经学预后显着相关。516)与SAH患者的神经系统不良结局显着相关。CRP的早期连续测量可用于预测SAH患者的神经系统结果。此外,SAH后四天内的最高CRP水平与不良的神经学预后显着相关。
更新日期:2020-04-22
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