C-Reactive Protein Predicts Neurological Outcomes of Subarachnoid Hemorrhage Patients

Subarachnoid hemorrhage (SAH) is a disease associated with high mortality. Survivors of SAH may manifest severe neurological deficits. In patients with SAH, early brain injury or delayed cerebral ischemia (DCI) is associated with poor outcomes.

C-reactive protein (CRP) is a useful marker of non-specific inflammation. Elevated CRP levels might be associated with the progression of vascular disease. Elevated levels of CRP are significantly associated with unfavorable long-term functional outcome in patients with ischemic stroke. The measurement of CRP significantly increases the ability to make accurate predictions and prevent or manage coronary thrombotic events appropriately.


Neurologists at the Samsung Medical Center (Seoul, Republic of Korea) carried out a retrospective, single-center, observational study of adult patients with SAH who were admitted to the neurosurgical intensive care unit (ICU) from January 2012 through June 2017. A total of 156 patients diagnosed with SAH were analyzed in the study. Initial brain CT and CT angiography were performed within 12 hours from the onset of SAH.

Initial CRP levels were measured within 12 hours after admission. The day of admission was defined as day 1. CRP data on days 1 to 7 were collected. Serum CRP levels were measured using the CRPL₃ immunoturbidimetric assays (Roche Diagnostics, Indianapolis, IN, USA) with a lower reference limit of 0.3 mg/dL. The maximal level of CRP (CRP_Max) was defined as the peak level from days 1 through 4. Subsequent CRP (CRP_min) level was determined as the minimal level from days 5 to 7.

The scientists reported that among 156 patients with SAH, 145 (92.9%) survived until discharge. Of these survivors, 109 (69.9%) manifested favorable neurological outcomes. 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. 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. The maximal CRP levels within four days facilitate the prediction of neurological outcomes of SAH patients without surgical clipping.

The authors concluded that 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. The study was published on march 27, 2020 in the journal BMC Neurology.

Related Links:
Samsung Medical Center
Roche Diagnostics