High-sensitivity C-reactive protein as a predictive factor of acute kidney injury following aneurysmal subarachnoid hemorrhage: a prospective observational study

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High-sensitivity C-reactive protein (hs-CRP) is a well-recognized biomarker of neurologic complications and clinical outcome of stroke patients. However, whether hs-CRP can predict the occurrence of acute kidney injury (AKI) in aneurysmal subarachnoid hemorrhage (aSAH) patients is still unclear. The objective of this study was to assess the feasibility of using serum hs-CRP level to predict the occurrence of AKI in aSAH patients.


One hundred sixty-four aSAH patients were enrolled into a prospective observational study. AKI was diagnosed using the modified Kidney Disease Improving Global Outcomes (KDIGO) standard. The relationship between serum hs-CRP level at admission and occurrence of AKI was analyzed.


AKI occurred in 17 patients (10.4%) in this cohort. Patients with AKI had significantly higher hs-CRP levels than those without. The mortality of the AKI group tends to be higher than that of the non-AKI group, but the difference was not statistically significant (4/17 (23.5%) vs. 13/147 (8.8%), P = 0.081). After adjusting for possible confounding factors including World Federation of Neurosurgical Societies grade, diabetes, and serum creatinine, multivariate analysis revealed that serum hs-CRP level and antibiotic therapy were both significant factors independently associated with AKI following aSAH (serum hs-CRP: OR = 1.2, 95% confidence interval (CI) = 1.1–1.3, P = 0.003; antibiotic therapy: OR = 5.8, 95%CI = 1.6–20.7, P = 0.007). Receiver operating characteristic curve analysis showed that hs-CRP had a sensitivity of 76.5% and a specificity of 64.6% for predicting the development of AKI on the basis of the best thresholds. The post hoc log-rank test revealed that patients having serum hs-CRP level > 6.6 mg/L had a significantly higher AKI rate than patients having serum hs-CRP level ≤ 6.6 mg/L (P = 0.001).


Serum hs-CRP level might be helpful as a predictor for the development of AKI in aSAH patients. Delayed cerebral ischemia occurrence rate and mortality of patients with AKI tend to be higher than those of patients without in this cohort; however, they were not significantly different.

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Fig. 1
Fig. 2

Change history



High-sensitivity C-reactive protein


Acute kidney injury


Aneurysmal subarachnoid hemorrhage


Computed tomography angiography


Digital subtraction angiography


World Federation of Neurosurgical Societies


Magnetic resonance angiography


Cerebrospinal fluid


Kidney Disease Improving Global Outcomes


Receiver operating characteristic


Area under the curve


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We are grateful to all colleagues who participated in providing cases (Dr. Jiawei Cai and Dr. Fuxin Lin).


This study was supported by grants from the Key Clinical Specialty Discipline Construction Program of Fujian, P.R.C., and the major project of Fujian Provincial Department of Science and Technology (No. 2014YZ0003).

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Corresponding author

Correspondence to Qing-Xi Tang.

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Conflict of interest

De-Zhi Kang received grants from the Key Clinical Specialty Discipline Construction Program of Fujian, P.R.C., and the major project of Fujian Provincial Department of Science and Technology (No. 2014YZ0003). All other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All procedures in the study were approved by the Ethics Committee of the First Affiliated Hospital of Fujian Medical University (Fujian, China).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information


This paper reports an association between admission plasma levels of high-sensitivity C-reactive protein and development within 14 days of acute kidney injury in patients with aneurysmal subarachnoid haemorrhage. This is an interesting observation, which warrants consideration regarding the mechanism of association. However, as a clinician I probably would not add this relatively expensive test to my prognostic toolbox at this time.

Kirsten Moeller

Copenhagen, Denmark

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This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Yang, BH., He, Q., Ding, CY. et al. High-sensitivity C-reactive protein as a predictive factor of acute kidney injury following aneurysmal subarachnoid hemorrhage: a prospective observational study. Acta Neurochir 161, 1783–1791 (2019). https://doi.org/10.1007/s00701-019-04006-z

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  • Acute kidney injury
  • Aneurysmal subarachnoid hemorrhage
  • High-sensitivity C-reactive protein