Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage - Serum D-dimer and C-reactive Protein as Early Markers
| Autor: | Ulrich Birkenhauer, Jochen Steiner, Florian Hennersdorf, Dennis Schlak, Helene Hurth, Florian Heinrich Ebner |
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| Rok vydání: | 2019 |
| Předmět: |
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medicine.medical_specialty Subarachnoid hemorrhage Time Factors Ischemia Procalcitonin Brain Ischemia Fibrin Fibrinogen Degradation Products 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Risk Factors Internal medicine D-dimer medicine Humans Vasospasm Intracranial cardiovascular diseases Retrospective Studies biology business.industry Glasgow Outcome Scale Rehabilitation C-reactive protein Vasospasm Intracranial Aneurysm Middle Aged Subarachnoid Hemorrhage medicine.disease Prognosis C-Reactive Protein Early Diagnosis biology.protein Cardiology Surgery Female Neurology (clinical) Neurosurgery Intracranial Thrombosis Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery Biomarkers |
| Zdroj: | Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 29(3) |
| ISSN: | 1532-8511 |
| Popis: | Background Identifying patients at risk for delayed cerebral ischemia after an aneurysmal subarachnoid hemorrhage remains challenging and both delayed treatment and over-treatment are reasonable concerns. Objective To evaluate the role of the serum markers C-reactive protein, white blood count, and d-dimer as prognostic factors for the occurrence of delayed cerebral ischemia. Methods All patients admitted within 24 hours after an aneurysmal subarachnoid hemorrhage were included over a 6-year period. The World Federation of Neurosurgery and Fisher grading scales as well as the extended Glasgow Outcome Scale were documented at discharge and after a 3-to-6-month follow-up period. C-reactive protein, d-dimer, white blood count, and procalcitonin were assessed on admission, day 1, day 4, day 9, day 14, and at discharge. Radiologically confirmed delayed cerebral ischemia before discharge was the primary endpoint. Severe angiographic vasospasm and outcome were used as secondary endpoints. Results Delayed cerebral ischemia occurred in 19.6% of the 138 patients included. Delayed cerebral ischemia correlated with severe vasospasm and with a worse outcome. Serum C-reactive protein levels were higher in patients with severe vasospasm during the period of vasospasm. D-dimer levels on admission correlated with Fisher grades. Delayed cerebral ischemia occurred more frequently in patients with Fisher grade IV hemorrhage, if d-dimer levels were higher on admission. The cut-off was .445 µg/ml. Conclusion Our observations support a multifactorial genesis for delayed cerebral ischemia, including vasospasm and microthrombotic and inflammatory processes. Serum d-dimer levels greater than .445 µg/ml might be a predictor for the occurrence of delayed cerebral ischemia in patients with a Fisher grade IV aneurysmal subarachnoid hemorrhage. |
| Databáze: | OpenAIRE |
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