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

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.