CRP (C-Reactive Protein) in Outcome Prediction After Subarachnoid Hemorrhage and the Role of Machine Learning

Gaastra, Ben; Barron, Peter; Newitt, Laura; Chhugani, Simran; Turner, Carole; Kirkpatrick, Peter J.; MacArthur, Ben D.; Galea, Ian; Bulters, Diederik

doi:10.1161/strokeaha.120.030950

Cited by 29 publications

(20 citation statements)

References 28 publications

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“…In our study, the poor-prognosis aSAH patients had a higher neutrophil count, similar to previous reports [18]. High CRP levels have been shown to correlate with the severity of aSAH, and though the underlying mechanism remains obscure, CRP could be used as a reliable prognostic factor in aSAH patients [20].…”

Section: Discussionsupporting

confidence: 90%

D-dimer/albumin ratio is a prognostic marker for patients with aneurysmal subarachnoid hemorrhage-retrospective research

Liu

Chen

et al. 2022

Preprint

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Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a serious neurological disorder with limited treatment options and very little is known about its pathophysiology. And there are few available objective tools for predicting the clinical prognosis of aSAH patients and further aiding in directing clinical therapeutic programs. This study aimed to evaluate whether the raised serum D-dimer/albumin ratio (DAR) could reflect disease severity and predict clinical outcomes after aSAH.Methods: A total of 178 patients with aSAH were included in this retrospective study. Collected data included demographics; clinical severity of aSAH (WFNS scale and Hunt-Hess scale), levels of D-dimer, albumin, c-reactive protein (CRP), leukocyte counts, mRS on admission; and three-month prognosis. Clinical prognosis was dichotomized into favorable outcome (mRS ≤ 2) and unfavorable outcome (mRS ≥ 3). And the predictive ability of DAR for aSAH prognosis was determined by Receiver Operating Characteristic (ROC) Curve analysis.Results: The serum DAR showed a strong positive correlation with disease severity. Univariate analysis revealed that DAR, WFNS grade, Hunt-Hess grade, delayed cerebral infarction (DCI), age, neutrophil-to-lymphocyte ratio (NLR), and c-reactive protein/albumin ratio (CAR) were associated with unfavorable clinical outcome. Multivariate regression analysis further revealed that elevated DAR could predict poor prognosis after correcting for WFNS grade, Hunt-Hess grade, DCI, age, NLR, and CRP/albumin ratio. The receiver operating characteristic curve result demonstrated that DAR was a comparable predictor for clinical outcome of aSAH in comparison with NLR and CAR.Conclusion: DAR was d promising objective tool for aSAH patients. Hight content DAR was associate with disease severity and unfavorable short-term prognosis.

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Section: Discussionsupporting

confidence: 90%

D-dimer/albumin ratio is a prognostic marker for patients with aneurysmal subarachnoid hemorrhage-retrospective research

Liu

Chen

et al. 2022

Preprint

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“…In addition to age and genetic ancestry, a number of variables have been shown to predict outcome following aSAH. These predictors include baseline characteristics such as the World Federation of Neurological Surgeons (WFNS) score [4] and features of the patient's clinical course, for example, aneurysm treatment modality [40], rebleed and delayed cerebral ischemia (DCI) [41]. As these variables are expected to influence outcome but not an individual's genetic profile, they are not considered as confounding variables (Fig.…”

Section: Additional Covariatesmentioning

confidence: 99%

Genome-Wide Association Study of Clinical Outcome After Aneurysmal Subarachnoid Haemorrhage: Protocol

Gaastra

Alexander

Bakker

et al. 2022

Transl. Stroke Res.

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Aneurysmal subarachnoid haemorrhage (aSAH) results in persistent clinical deficits which prevent survivors from returning to normal daily functioning. Only a small fraction of the variation in clinical outcome following aSAH is explained by known clinical, demographic and imaging variables; meaning additional unknown factors must play a key role in clinical outcome. There is a growing body of evidence that genetic variation is important in determining outcome following aSAH. Understanding genetic determinants of outcome will help to improve prognostic modelling, stratify patients in clinical trials and target novel strategies to treat this devastating disease. This protocol details a two-stage genome-wide association study to identify susceptibility loci for clinical outcome after aSAH using individual patient-level data from multiple international cohorts. Clinical outcome will be assessed using the modified Rankin Scale or Glasgow Outcome Scale at 1–24 months. The stage 1 discovery will involve meta-analysis of individual-level genotypes from different cohorts, controlling for key covariates. Based on statistical significance, supplemented by biological relevance, top single nucleotide polymorphisms will be selected for replication at stage 2. The study has national and local ethical approval. The results of this study will be rapidly communicated to clinicians, researchers and patients through open-access publication(s), presentation(s) at international conferences and via our patient and public network.

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“…Gaastra et al ( 18 ) reported that CRP is an independent predictor of postoperative functional outcome in patients with aSAH, and elevated CRP values at the initial stage of bleeding are closely related to the functional outcome of clinical prognosis ( 19 , 20 ). CRP is an acute-phase protein produced by the liver ( 8 , 9 ).…”

Section: Discussionmentioning

confidence: 99%

“…Under the action of trauma or inflammatory factors, the liver will rapidly produce CRP and release it into the peripheral blood. At this time, CRP in peripheral blood is elevated ( 12 , 16 – 18 ). However, CRP is a non-specific inflammatory marker that can be elevated in the presence of any tissue damage ( 10 , 11 ), therefore, its clinical value can be improved in combination with other inflammatory indicators.…”

Section: Discussionmentioning

confidence: 99%

Clinical Value and Prognosis of C Reactive Protein to Lymphocyte Ratio in Severe Aneurysmal Subarachnoid Hemorrhage

Zhang

Wang

et al. 2022

Front. Neurol.

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ObjectiveTo investigate the relationship between CLR and disease severity and clinical prognosis of aSAH.MethodsThe authors retrospectively analyzed the clinical data of 221 patients with aSAH, who were admitted to the intensive care unit from January 2017 to December 2020. The indicators of inflammatory factors in the first blood routine examination within 48 h of bleeding were obtained. The prognosis was evaluated by mRS score at discharge, mRS>2 was a poor outcome. Through the receiver operating characteristic (ROC) curve, the area under the curve was calculated and the predicted values of inflammatory factors (CLR, CRP, WBC, and neutrophils) were compared. Univariate and multivariable logistic regression analyses were used to evaluate the relationship between CLR and the clinical prognosis of patients. ROC curve analysis was performed to determine the optimal cut-off threshold, sensitivity, and specificity of CLR in predicting prognosis at admission.ResultsAccording to the mRS score at discharge, 139 (62.90%) patients were classified with poor outcomes (mRS>2). The inflammatory factor with the best predictive value was CLR, which had an optimal cut-off threshold of 10.81 and an area under the ROC curve of 0.840 (95%CI.788–0.892, P < 0.001). Multivariable Logistic regression analysis showed that the Modified Fisher grade, Hunt-Hess grade, and CLR at admission were independent risk factors for poor outcomes of patients with aSAH (P < 0.05). According to Hunt-Hess grade, patients were divided into a mild group (Hunt-Hess ≤ 3) and a severe group (Hunt-Hess > 3), and the CLR value was significantly higher in severe patients with aSAH than in mild patients. The optimal cut-off threshold of CLR in the severe group was 6.87, and the area under the ROC curve was 0.838 (95% CI.752–0.925, P < 0.001).ConclusionsThe CLR value at the admission of patients with aSAH was significantly associated with Hunt-Hess grade, The higher Hunt-Hess grade, the higher the CL R-value, and the worse the prognosis. Early CLR value can be considered as a feasible biomarker to predict the clinical prognosis of patients with aSAH.

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CRP (C-Reactive Protein) in Outcome Prediction After Subarachnoid Hemorrhage and the Role of Machine Learning

Cited by 29 publications

References 28 publications

D-dimer/albumin ratio is a prognostic marker for patients with aneurysmal subarachnoid hemorrhage-retrospective research

D-dimer/albumin ratio is a prognostic marker for patients with aneurysmal subarachnoid hemorrhage-retrospective research

Genome-Wide Association Study of Clinical Outcome After Aneurysmal Subarachnoid Haemorrhage: Protocol

Clinical Value and Prognosis of C Reactive Protein to Lymphocyte Ratio in Severe Aneurysmal Subarachnoid Hemorrhage

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