Associations Between Levels of High-Sensitivity C-Reactive Protein and Outcome After Intracerebral Hemorrhage

Association of C-Reactive Protein with Short-Term Outcomes in Spontaneous Intracerebral Hemorrhage Patients with or without Infection: From a Large-Scale Nationwide Longitudinal Registry

Aim

To study the relationship between elevated C-reactive protein (CRP) levels, infection, and spontaneous intracerebral hemorrhage (ICH) outcomes.

Methods

Patients were classified into four groups (Q1-Q4). Logistic regression was used to analyze the relationship between different CRP levels and functional disability (mRS score of 3-5) at discharge, intracerebral hematoma evacuation, and in-hospital mortality. Subgroup analysis was conducted on patients with or without infection during hospitalization.

Results

A total of 14,529 patients with ICH were enrolled in this study. In the multivariate logistic regression model, compared with the reference CRP quartile group (Q1), the Q4 group had a higher proportion of functional disability (adjusted OR, 1.30, 95% CI 1.16-1.45) and hematoma evacuation (adjusted OR, 1.88, 95% CI 1.58-2.23). In patients without infection, compared with the Q1 group, the Q4 group had a higher risk of functional disability (adjusted OR, 2.16, 95% CI 1.71-2.73) and hematoma evacuation (adjusted OR, 1.15, 95% CI 1.00-1.31).

Conclusion

A significantly increased CRP level was associated with a higher risk of early functional disability and hematoma evacuation in patients with ICH, regardless of the presence or absence of infectious complications. Infection may increase the risk of poor outcomes in patients with ICH, but caution is needed when facing abnormally high CRP levels in patients with ICH without infection.

C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians

The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.

High Serum S100A12 Levels Predict Poor Outcome After Acute Primary Intracerebral Hemorrhage

OBJECTIVE

Intracerebral hemorrhage (ICH) triggers an inflammatory cascade that damages brain tissues and worsens functional outcome. S100A12 functions to promote brain inflammation. We aimed to investigate the relationship between serum S100A12 levels and functional outcome in ICH patients.

METHODS

Serum S100A12 levels were measured in 101 ICH patients hospitalized within 24 h after symptom onset. Poor functional outcome was defined as a modified Rankin scale of 3 or greater at 3 months after stroke. Early neurologic deterioration was defined as an increase of ≥4 points in the National Institutes of Health Stroke Scale (NIHSS) score or death at 24 hours from symptoms onset.

RESULTS

High serum S100A12 levels were independently correlated with NIHSS score (t = 5.384, P < 0.001), hematoma volume (t = 4.221, P < 0.001) and serum C-reactive protein levels (t = 5.068, P < 0.001). Serum S100A12 levels were substantially higher in patients with a poor outcome (median, 66.5 versus 37.7 ng/mL; P < 0.001) or early neurological deterioration (median, 76.5 versus 40.1 ng/mL; P < 0.001) than in the other remainders, independently predicted a poor outcome (odds ratio, 1.035; 95% confidence interval, 1.007-1.064; P = 0.015) and early neurologic deterioration (odds ratio,1.032; 95% confidence interval, 1.003-1.060; P = 0.027), and significantly discriminated a poor outcome (area under curve, 0.794; 95% confidence interval, 0.702-0.868) and early neurologic deterioration (area under curve, 0.760; 95% confidence interval, 0.664-0.839) under receiver operating characteristic curve.

CONCLUSION

High serum S100A12 levels at admission are highly associated with the extent of inflammatory response, severity, a poor functional outcome and early neurologic deterioration in ICH patients, substantializing serum S100A12 as a promising prognostic biomarker for ICH.