Subaraknoid Kanama Hastalarında C-Reaktif Protein Düzeylerinin Prognostik Gösterge Olarak Değerlendirilmesi

Abstract

Amaç: Subaraknoid kanama (SAK), genellikle ciddi komplikasyonlara yol açan ve yüksek mortalite oranlarına sahip, yaşamı tehdit eden bir durumdur. Klinik sonuçları öngörebilecek güvenilir biyobelirteçlerin tanımlanması, hasta yönetimini iyileştirmeye ve tedavi yaklaşımlarını bireyselleştirmeye katkı sağlayabilir. Bu çalışmanın amacı, SAK hastalarında ilk 14 gün içinde C-reaktif protein (CRP) düzeylerinin fonksiyonel iyileşme, vazospazm insidansı ve mortalite gibi klinik sonuçları öngörmedeki prognostik değerini değerlendirmektir. Gereç ve Yöntemler: 2018 ile 2024 yılları arasında spontan SAK tanısı almış 263 hastanın retrospektif analizi yapıldı. Dijital subtraksiyon anjiyografi bulgularına göre hastalar anevrizmal SAK (ASAK) ve anevrizma dışı SAK (ADSAK) olarak sınıflandırıldı. CRP düzeyleri 14 gün boyunca günlük olarak ölçüldü ve klinik sonuçlar Modifiye Rankin Skalası ve Kaplan-Meier sağkalım analizi ile değerlendirildi. Bulgular: ASAK hastalarında CRP düzeyleri anlamlı olarak daha yüksekti (medyan: 516 mg/L) ve CRP >100 mg/L süresi ADSAK hastalarına göre daha uzundu. Yüksek CRP düzeyleri, daha kötü mRS skorları ve artmış vazospazm insidansı ile pozitif korelasyon gösterdi. Sağkalım analizinde, CRP >200 mg/L olan ASAK hastalarının sağkalım oranı (%45), daha düşük CRP düzeyine sahip olanlara kıyasla (%72) anlamlı olarak daha düşüktü (p < 0.001). Sonuç: Yüksek CRP düzeyleri, özellikle anevrizma rüptürü olan hastalarda, kötü fonksiyonel sonuçlar, artmış vazospazm ve yüksek mortalite ile güçlü bir şekilde ilişkilidir. CRP izleminin rutin klinik pratiğe dahil edilmesi, prognoz tahminini güçlendirebilir ve hedefe yönelik tedavilere yön verebilir.

Keywords

• Subaraknoid kanama
• C-reaktif protein
• vazospazm
• prognoz
• biyobelirteçler

Evaluation of C-Reactive Protein Levels as Prognostic Indicators in Subarachnoid Hemorrhage Patients

Abstract

Aim: Subarachnoid hemorrhage (SAH) is a life-threatening condition often leading to severe complications such as cerebral vasospasm, delayed cerebral ischemia, and high mortality rates. Identifying reliable biomarkers to predict clinical outcomes can aid in improving patient management and tailoring therapeutic interventions. This study aims to evaluate the prognostic value of C-reactive protein (CRP) levels in predicting clinical outcomes, including functional recovery, incidence of vasospasm, and mortality, in SAH patients within the first 14 days post-hemorrhage Material and Methods: A retrospective analysis of 263 patients diagnosed with spontaneous SAH between 2018 and 2024 was conducted. Patients were classified into aneurysmal SAH (ASAH) and non-aneurysmal SAH (NASAH) groups based on digital subtraction angiography findings. CRP levels were measured daily for 14 days, and clinical outcomes were assessed using the Modified Rankin Scale and Kaplan- Meier survival analysis. Results: Patients with ASAH exhibited significantly higher CRP levels (median: 516 mg/L) and longer durations of CRP >100 mg/L compared to NASAH patients. Higher CRP levels correlated positively with worse mRS scores and increased vasospasm incidence. Survival analysis revealed that ASAH patients with CRP >200 mg/L had significantly reduced survival rates (45%) compared to those with lower CRP levels (72%, p < 0.001). Conclusion: Elevated CRP levels are strongly associated with poor functional outcomes, increased vasospasm, and higher mortality in SAH patients, particularly in those with aneurysmal rupture. Incorporating CRP monitoring into routine clinical practice may enhance prognostication and guide targeted therapies

Keywords

• Subarachnoid hemorrhage
• C-reactive protein
• vasospasm
• prognosis
• biomarkers

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