Leucocytosis and C-reactive protein as predictors of secondary cerebral vasospasm and delayed cerebral ischemia in patients with aneurysmal subarachnoid haemorrhage

Aneurysmal subarachnoid haemorrhage (SAH) stays a distorting pathology due to the late complications - secondary vasospasm (SV) and delayed cerebral ischemia (DCI). Up to 60% of patients develop systemic inflammatory response syndrome. Aim was to investigate association of white blood cell (WBC) count and C-reactive protein (CRP) values with occurrence of SV and DCI. Retrospectively medical records of 201 patient admitted in Intensive Care Unit (ICU) of Riga East University Hospital with aneurysmal SAH in three-year period were reviewed. As a primary outcome we analysed association of WBC count and CRP values at admission and on the third day with the occurrence of SV and DCI. Secondary – correlation of WBC and CRP with Fisher score, length of stay in ICU and outcome. Significance p<0.05. 107 patients were divided into three groups: n=25 (SAH-SV), n=25 (SAH-DCI), n=72 (SAH). Mean WBC count at admission was 11.2±3.7x109/L vs. 13.2±3.3x109/L in SAH vs. SAH-SV (p=0.01). CRP levels were higher in SAH-SV 15.7±17.1 mg/L vs. 5.5±12.2 mg/L (p<0.005). WBC and CRP values at admission not differed between SAH-DCI and SAH (p=0.233, p=0.106). On the third day, WBC count was not significantly higher in SAH-SV anymore (p=0.112). Although, CRP level increased to 31.5±50 mg/L vs. 54.2±88 mg/L (SAH vs. SAH-SV), significance was not found (p=0.137) like also between SAH-DCI and SAH. Correlation was detected between WBC count at admission and Fisher score (r=0.218, p=0.032) and higher CRP values at admission had higher mortality rates (r=0.4, p<0.05) in SAH-SV. Patients with greater WBC count and CRP values at admission stayed longer in ICU - 13±15 vs. 5±5 days in SAH-SV vs.SAH, p=0.002 and p=0.003. Aneurysmal SAH patients with higher values of WBC and CRP at admission have greater risk to develop SV and stay longer in ICU, but higher CRP values is associated with higher mortality.