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The Postoperative C-reactive Protein Level can be a Useful Prognostic Factor for Poor Outcome and Symptomatic Vasospasm in Patients With Aneurysmal Subarachnoid Hemorrhage

Jeon, Young-Tae MD*; Lee, Ju-Hyun MD; Lee, Hannnah MD; Lee, Hye-Kyoung MD; Hwang, Jung-Won MD*; Lim, Young-Jin MD; Park, Hee-Pyoung MD

Journal of Neurosurgical Anesthesiology: October 2012 - Volume 24 - Issue 4 - p 317–324
doi: 10.1097/ANA.0b013e31826047a2
Clinical Investigations

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 POD1-2) 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.

*Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea

The authors have no funding or conflicts of interest to disclose.

Reprints: Hee-Pyoung Park, MD, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 103 Daehangno, Jongno-gu, Seoul 110-744, South Korea (e-mail:

Received April 27, 2011

Accepted May 18, 2012

© 2012 Lippincott Williams & Wilkins, Inc.