The Postoperative C-reactive Protein Level can be a Useful Prognostic Factor for Poor Outcome and Symptomatic Vasospasm in Patients With Aneurysmal Subarachnoid Hemorrhage
The Postoperative C-reactive Protein Level can be a Useful Prognostic Factor for Poor Outcome and Symptomatic Vasospasm in Patients With Aneurysmal Subarachnoid Hemorrhage
复制标题
DOI：
10.1097/ana.0b013e31826047a2
复制
发表时间：
2012-10-01
影响因子：
3.7
通讯作者：
Park, Hee-Pyoung
中科院分区：
文献类型：
--
作者：
Jeon, Young-Tae;Lee, Ju-Hyun;Park, Hee-Pyoung
背景：回顾分析93例继发于动脉瘤性蛛网膜下腔出血(SAH)的外科或血管内手术患者，探讨不同时点C反应蛋白(CRP)检测对预测血管痉挛及临床转归的影响。方法：对93例SAH患者的术前、术后人口学及临床资料，术中及术后并发症，如脑出血、脑积水、血管痉挛、脑出血、脑积水、血管痉挛、分别在出院时或症状性血管痉挛时行手术减压，作为预后不良的预测因素(改良Rankin评分4~6分)。结果：23例28例蛛网膜下腔出血患者均出现不良预后和症状性血管痉挛。预后不良的患者术前、术后CRP水平均显著高于预后良好的患者(P<；0.05)。术后第1、2天测定的C-反应蛋白受试者工作特征曲线下面积(CRPpodi-2)预测不良临床结局的面积为0.870，其4 mg/dL的临界点的敏感性为0.826，特异性为0.843。动脉瘤治疗后的高C反应蛋白水平与入院时严重的神经恶化、脑梗塞、脑出血和手术减压相关(P<；0.05)。C反应蛋白POD 1-2，而不是术前C反应蛋白是预测症状性血管痉挛的独立因素(P<；0.05)。在症状性血管痉挛患者中，术后CRP的升高与症状性血管痉挛发生的时间相关。结论：术后CRP，尤其是CRPPOD1-2可作为预测动脉瘤性SAH患者预后不良和症状性血管痉挛的有用指标。
Background: Ninety-three patients undergoing surgical or endovascular operation secondary to aneurysmal subarachnoid hemorrhage (SAH) were retrospectively analyzed to determine the influence of the different time points of C-reactive protein (CRP) measurement on the prediction of vasospasm and clinical outcome.Methods: Laboratory data such as the CRP level and the white blood cell count, preoperative demographic and clinical data, intraoperative and postoperative data, and complications such as intracerebral hemorrhage, hydrocephalus, vasospasm, and surgical decompression were collected at hospital discharge or symptomatic vasospasm and used as predictable factors for poor outcome (Modified Rankin Scale score 4 to 6).Results: Twenty-three and 28 patients showed poor outcome and symptomatic vasospasm after SAH, respectively. Both preoperative and postoperative CRP levels were significantly higher in patients with a poor outcome compared with patients with a good outcome (P < 0.05). The area under the receiver operating characteristic curve of CRP measured on postoperative day 1 or 2 (CRP PODI-2) for predicting a poor clinical outcome was 0.870, and its cutoff point of 4 mg/dL had a sensitivity of 0.826 and a specificity of 0.843. A high CRP level after aneurysm treatment was associated with severe neurological deterioration on admission, cerebral infarction, intracerebral hemorrhage, and surgical decompression (P < 0.05). CRP POD1-2, and not the preoperative CRP, was an independent factor in predicting symptomatic vasospasm (P < 0.05). In patients with symptomatic vasospasm, an increase in the postoperative CRP was associated with the time profile of developing symptomatic vasospasm.Conclusion: Postoperative CRP, especially CRP POD1-2, can be a useful prognostic factor for both poor outcome and symptomatic vasospasm in patients with aneurysmal SAH.