Blood C-reactive protein and white blood cells trajectories and associations with clinical parameters and complications in the acute phase after subarachnoid hemorrhage

Abstract

Background

Inflammation holds a central role in the pathophysiology of subarachnoid hemorrhage (SAH). Two common non-specific inflammatory markers, C – reactive protein (CRP) and White Blood Cells (WBC), were analyzed in blood of SAH patients and their temporal patterns and associations with bleeding severity and complications were studied.

Methods

The charts of 552 SAH patients admitted between 01.01.2015 – 31.12.2019 were retrospectively analyzed through our clinic’s database. Blood concentrations of CRP (reference range < 5 mg/L) and WBC counts (reference range 3.5–9 × 10⁹/L) were extracted and their temporal trajectories from Day 1 to Day 10 post ictus were recorded. Associations of Day 1 and Day 4 CRP and WBC values with clinical parameters including age, sex, identifiable bleeding source, bleeding severity based on Fisher scale, neurologic status on admission based on Reaction Level Scale-85 (RLS-85) score, occurrence of External Ventricular Drainage (EVD), infections, and Delayed Ischemic Neurologic Deficit (DIND) were examined. Mann Whitney U test was used for univariate analyses in dichotomized groups and General linear/nonlinear models with best subsets of variables based on Akaike’s Information Criterion for multivariate analyses.

Results

CRP peaked on Day 4 and WBC on Day 1. Univariate analyses showed that patients with more severe hemorrhage (i.e., identifiable bleeding source, Fisher 3–4, RLS 4–8, EVD indication) and complications (infections, DIND) had significantly higher CRP and WBC values on Day 1 and Day 4. Multivariate analyses showed that DIND was among the variables included in the three models most likely to be associated with higher Day 4 WBC but not CRP values.

Conclusions

More severe bleeding and occurrence of complications in the early phase of SAH are associated with a more intense inflammatory response. An increase in WBC (rather than CRP) around Day 4 post ictus may be associated with the occurrence of DIND.