RESUMO
PURPOSE: To evaluate the relationship between C reactive protein levels and clinical and radiological parameters with delayed ischemic neurological deficits and outcome after aneurysmal subarachnoid hemorrhage. METHODS: One hundred adult patients with aneurismal SAH were prospectively evaluated. Besides the baseline characteristics, daily C-reactive protein levels were prospectively measured until day 10 after subarachnoid hemorrhage. The primary end point was outcome assessed by Glasgow Outcome Scale, the secondary was the occurrence of delayed ischemic neurological deficits (DINDs). RESULTS: A progressive increase in the CRP levels from the admission to 3rd postictal day was observed, followed by a slow decrease until the 9th day. Hemodynamic changes in TCD were associated with higher serum CRP levels. Patients with lower GCS scores presented with increased CRP levels. Patients with higher Hunt and Hess grades on admission developed significantly higher CRP serum levels. Patients with higher admission Fisher grades showed increased levels of CRP. A statistically significant inverse correlation was established in our series between CRP serum levels and GOS on discharge and CRP levels. CONCLUSIONS: Higher C-reactive protein serum levels are associated with worse clinical outcome and the occurrence of delayed ischemic neurological deficits. Because C-reactive protein levels were significantly elevated in the early phase, they might be a useful parameter to monitor.
Assuntos
Proteína C-Reativa/análise , Hemorragia Subaracnóidea/sangue , Vasoespasmo Intracraniano/sangue , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Feminino , Escala de Resultado de Glasgow , Hemodinâmica , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Hemorragia Subaracnóidea/complicações , Fatores de Tempo , Ultrassonografia Doppler Transcraniana , Vasoespasmo Intracraniano/etiologia , Adulto JovemRESUMO
PURPOSE: To evaluate the relationship between C reactive protein levels and clinical and radiological parameters with delayed ischemic neurological deficits and outcome after aneurysmal subarachnoid hemorrhage. METHODS: One hundred adult patients with aneurismal SAH were prospectively evaluated. Besides the baseline characteristics, daily C-reactive protein levels were prospectively measured until day 10 after subarachnoid hemorrhage. The primary end point was outcome assessed by Glasgow Outcome Scale, the secondary was the occurrence of delayed ischemic neurological deficits (DINDs). RESULTS: A progressive increase in the CRP levels from the admission to 3rd postictal day was observed, followed by a slow decrease until the 9th day. Hemodynamic changes in TCD were associated with higher serum CRP levels. Patients with lower GCS scores presented with increased CRP levels. Patients with higher Hunt and Hess grades on admission developed significantly higher CRP serum levels. Patients with higher admission Fisher grades showed increased levels of CRP. A statistically significant inverse correlation was established in our series between CRP serum levels and GOS on discharge and CRP levels. CONCLUSIONS: Higher C-reactive protein serum levels are associated with worse clinical outcome and the occurrence of delayed ischemic neurological deficits. Because C-reactive protein levels were significantly elevated in the early phase, they might be a useful parameter to monitor. .
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Proteína C-Reativa/análise , Hemorragia Subaracnóidea/sangue , Vasoespasmo Intracraniano/sangue , Biomarcadores/sangue , Escala de Resultado de Glasgow , Hemodinâmica , Modelos Logísticos , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Hemorragia Subaracnóidea/complicações , Fatores de Tempo , Ultrassonografia Doppler Transcraniana , Vasoespasmo Intracraniano/etiologiaRESUMO
OBJECTIVES: Our aim was to evaluate the relationship between serum C-reactive protein (CRP) levels and the neurological prognosis and development of vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS: Eighty-two adult patients with aSAH diagnoses were prospectively evaluated. Glasgow Coma Scale (GCS) score, Hunt and Hess grade, Fisher grade, cranial CT scans, digital subtraction angiography studies and daily neurological examinations were recorded. Serial serum CRP measurements were obtained daily between admission and the tenth day. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS) were used to assess the prognosis. RESULTS: Serum CRP levels were related to severity of aSAH. Patients with lower GCS scores and higher Hunt and Hess and Fisher grades presented statistically significant higher serum CRP levels. Patients with higher serum CRP levels had a less favorable prognosis. CONCLUSIONS: Increased serum CRP levels were strongly associated with worse clinical prognosis in this study.
Assuntos
Proteína C-Reativa/análise , Hemorragia Subaracnóidea/sangue , Vasoespasmo Intracraniano/sangue , Biomarcadores/sangue , Estudos de Coortes , Escala de Coma de Glasgow , Humanos , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/complicações , Vasoespasmo Intracraniano/etiologiaRESUMO
OBJECTIVES: Our aim was to evaluate the relationship between serum C-reactive protein (CRP) levels and the neurological prognosis and development of vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS: Eighty-two adult patients with aSAH diagnoses were prospectively evaluated. Glasgow Coma Scale (GCS) score, Hunt and Hess grade, Fisher grade, cranial CT scans, digital subtraction angiography studies and daily neurological examinations were recorded. Serial serum CRP measurements were obtained daily between admission and the tenth day. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS) were used to assess the prognosis. RESULTS: Serum CRP levels were related to severity of aSAH. Patients with lower GCS scores and higher Hunt and Hess and Fisher grades presented statistically significant higher serum CRP levels. Patients with higher serum CRP levels had a less favorable prognosis. CONCLUSIONS: Increased serum CRP levels were strongly associated with worse clinical prognosis in this study.
OBJETIVOS: Nosso propósito foi avaliar a relação entre os níveis séricos de proteína C-reativa (PCR), o prognóstico neurológico e o desenvolvimento de vasoespasmo em pacientes com hemorragia subaracnóidea aneurismática (HSAa). MÉTODOS: Foram avaliados prospectivamente 82 pacientes adultos com diagnóstico de HSAa. Foram anotados em prontuário: a escala de coma de Glasgow (ECG), a escala de Hunt-Hess, a escala de Fisher, TC de crânio, angiografia cerebral e o exame neurológico diário. Foi determinada diariamente a PCR sérica, da admissão ao décimo dia. Foi utilizadas a escala de resultados de Glasgow e a escala de Rankin modificada (mRS) para avaliar o prognóstico. RESULTADOS: Os níveis séricos de PCR estavam relacionados à severidade da HSAa. Pacientes com EGC baixos e altos graus pelas escalas de Hunt-Hess e Fisher tiveram níveis de PCR séricos estatisticamente elevados. Pacientes com altos níveis de PCR séricos tiveram prognóstico menos favorável. CONCLUSÕES: Aumentos dos níveis séricos da PCR foram fortemente associados com pior prognóstico clínico neste estudo.
Assuntos
Humanos , Proteína C-Reativa/análise , Hemorragia Subaracnóidea/sangue , Vasoespasmo Intracraniano/sangue , Biomarcadores/sangue , Estudos de Coortes , Escala de Coma de Glasgow , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/complicações , Vasoespasmo Intracraniano/etiologiaRESUMO
BACKGROUND: Plasma and cerebrospinal fluid (CSF) concentrations of endothelin-1 (ET-1) were measured in patients with subarachnoid hemorrhage (SAH) after aneurysmal rupture and compared with levels of ET-1 in volunteers. We analyze the relationship between levels of ET-1 in both CSF and plasma with the risk of developing cerebral vasospasm (CVS). METHODS: Cerebrospinal fluid and blood samples were collected from 30 selected patients after SAH and from 10 healthy volunteers who were used as control. All samples were stored at -70 degrees C and the levels of ET-1 in CSF and blood were measured by using enzyme-linked immunosorbent assay and Western blot. All patients were submitted to angiography to confirm vasospasm. RESULTS: From the 30 patients admitted at different days of SAH, 18 (60%) developed clinical CVS and 10 (33%) presented angiographic CVS. The levels of ET-1 in the CSF were significantly higher (P = .0001) in patients (1.618 +/- 1.05 fmol/mL) than in controls (0.365 +/- 0.328 fmol/mL). There was statistical difference (P < .05) in CSF levels of ET-1 between each group of the Hunt-Hess scale and controls. The mean plasma concentration of ET-1 was similar (P > .05) in the control group (1.531 +/- 0.753 fmol/mL) and in patients with SAH (1.920 +/- 1.15 fmol/mL). CONCLUSIONS: These findings indicate that a significant rise in ET-1 levels in the CSF, but not in the plasma, occurs in patients who develop CVS after SAH. Our observation suggests that ET-1 might be involved in the pathogenesis of SAH-associated CVS.