Associations between C-reactive protein and white blood cell count, occurrence of delayed cerebral ischemia and poor outcome following aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.
Associations between C-reactive protein and white blood cell count, occurrence of delayed cerebral ischemia and poor outcome following aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.
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DOI：
10.1007/s13760-020-01496-y
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发表时间：
2021-10
影响因子：
2.7
通讯作者：
Zhang Y
中科院分区：
文献类型：
--
作者：
Ma X;Lan F;Zhang Y
本综述和荟萃分析研究了全身炎症标志物C-反应蛋白（CRP）和白色血细胞计数（WBC）与蛛网膜下腔出血（aSAH）后迟发性脑缺血（DCI）和不良功能结局的相关性。检索了Pubmed、EMBASE和CENTRAL数据库，直至2019年11月30日，选择了动脉瘤破裂所致自发性SAH患者的前瞻性和回顾性研究。结局指标为DCI的发生，定义为新发局灶性神经功能缺损或意识恶化;和/或计算机断层扫描或磁共振成像显示的最初不可见的新发梗死。随访时采用改良兰金量表或格拉斯哥预后量表评估功能预后不良的发生率。纳入了15项分析3268例aSAH患者数据的研究。Meta分析显示，CRP早期升高与DCI发生风险增加显著相关（合并OR 1.30，95% CI 1.10-1.54; P = 0.002），而与功能结局不良无关（合并OR 1.02，95% CI 1.00-1.04，P = 0.052）。未观察到早期WBC增加与DCI之间的显著相关性（合并OR 1.13，95% CI 0.95-1.34; P = 0.179），而WBC增加与功能结局不良风险增加显著相关（合并OR 1.17，95% CI 1.07-1.28，P = 0.001）。早期血CRP升高似乎与SAH后DCI相关，而WBC升高与功能结局不良相关。然而，由于研究数量少、研究间异质性和怀疑非受控因素，无法得出强有力的结论。早期CRP和WBC是否可作为aSAH的预后指标有待进一步研究。本文的在线版本（10.1007/s13760-020-01496-y）包含补充材料，可供授权用户使用。
This review and meta-analysis investigated associations of systemic inflammatory marker C-reactive protein (CRP) and white blood cell count (WBC) with occurrence of delayed cerebral ischemia (DCI) and poor functional outcome after aneurysmal subarachnoid hemorrhage (aSAH). Pubmed, EMBASE, and CENTRAL databases were searched until November 30, 2019, selecting prospective and retrospective studies of patients with spontaneous SAH due to ruptured aneurysm. Outcome measures were occurrence of DCI, defined as new focal neurological deficit or a deterioration of consciousness; and/or a new infarct on computed tomography or magnetic resonance imaging that was not visible initially. Occurrence of poor functional outcome at follow-up were measured by modified Rankin Scale or Glasgow outcomes scale. Fifteen studies analyzing data of 3268 patients with aSAH were included. Meta-analysis revealed early increase in CRP was significantly associated with higher risk of occurrence of DCI (pooled OR 1.30, 95% CI 1.10–1.54; P = 0.002), whereas not with poor functional outcome (pooled OR 1.02, 95% CI 1.00–1.04, P = 0.052). No significant associations between early increase in WBC and DCI (pooled OR 1.13, 95% CI 0.95–1.34; P = 0.179) were observed, whereas increase in WBC was significantly associated with increased risk of poor functional outcome (pooled OR 1.17, 95% CI 1.07–1.28, P = 0.001). Early increase in blood CRP appears to correlate with DCI after SAH, while increase in WBC correlates with poor functional outcome. However, strong conclusion cannot be made due to the small study number, between-study heterogeneity and suspicion of uncontrolled factors. Whether early phase CRP and WBC may serve as prognostic markers for aSAH needs more investigation. The online version of this article (10.1007/s13760-020-01496-y) contains supplementary material, which is available to authorized users.
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影响因子：
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作者：
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通讯作者：
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