Association between systemic inflammation biomarkers and outcomes in patients with aneurysmal subarachnoid hemorrhage

Q: What are the key findings of this study?

The highest C-reactive protein (OR 1.003) and neutrophil-to-lymphocyte ratio (OR 1.025) values in the first 7 days after aneurysmal subarachnoid hemorrhage were independently associated with unfavorable neurological outcomes at 3 months.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Aneurysmal subarachnoid hemorrhage (aSAH) (n=547). Intervention: Elevated systemic inflammation biomarkers (CRP and NLr) vs. Lower levels of systemic inflammation biomarkers. Primary outcome: Unfavorable neurological outcome at 3 months (Glasgow Outcome Scale score of 1-3) (OR 1.003, 95% CI 1.001-1.005).

Q: What does this research mean for the field?

Elevated maximum levels of C-reactive protein and neutrophil-to-lymphocyte ratio within the first 7 days of aneurysmal subarachnoid hemorrhage are independently associated with unfavorable neurological outcomes at 3 months. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Maria Della Giovampaola; Andrea Vieno; Adeline Higuet; Irene Cavalli; Claudia Stella; Giacomo Coppalini; Alberto Diosdado; Daniel Damasceno; Lucas Pires Freitas; Fernando Oliveira Gomes; Ana Carolina Damasceno Lacerda Fernandes; Marcos Vinicius Tavares de Magalhães; Vinicius William Costa Dumont; F. S. Taccone; Elisa Gouvêa Bogossian

doi:10.3389/fneur.2026.1749871

March 17, 2026Frontiers in NeurologyOpen Access

Association between systemic inflammation biomarkers and outcomes in patients with aneurysmal subarachnoid hemorrhage

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Key result

High early CRP and NLR after subarachnoid hemorrhage link to unfavorable 3-month neurological outcomes.

OR 1.003
95% CI 1.001-1.005
n=547

Figures

Why the study?

Aneurysmal subarachnoid hemorrhage is linked to inflammation, but the impact of readily available systemic inflammation biomarkers CRP and NLr on outcomes needed evaluation.

Do elevated systemic inflammation biomarkers (CRP and NLr) predict unfavorable neurological outcomes and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage?

Study Design

Type

Cohort (n=547)

Multicenter

No

Structured PICO

Do elevated systemic inflammation biomarkers (CRP and NLr) predict unfavorable neurological outcomes and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage?

P

Population

547 adult patients (>18 years) admitted with aneurysmal subarachnoid hemorrhage (aSAH) to the intensive care unit, median age 54, 61.8% female, single-center (Belgium). Key exclusions: ICU stay less than 24 hours, missing admission CRP/blood counts, and pre-existing immunosuppression.

I

Intervention

Elevated systemic inflammation biomarkers (C-reactive protein [CRP] and neutrophil-to-lymphocyte ratio [NLr]) measured during the first 7 days of ICU stay

C

Comparator

Lower levels of CRP and NLr

O

Outcome

Unfavorable neurological outcome at 3 months, defined as a Glasgow Outcome Scale (GOS) score of 1-3 (death, persistent vegetative state, and severe disability)hard clinical

Main Result

Effect estimate: OR 1.003 (95% CI 1.001-1.005)

Limitations

Retrospective design subject to biases related to clinical recording and missing data
Single-center study, meaning results may only be applicable to cohorts with similar characteristics
Lack of available data regarding long-term neurological assessment beyond 3 months
Exclusion of patients who stayed less than 24 hours in the ICU, failing to study the impact of inflammatory biomarkers on early death
Inability to assess the presence of inflammatory biomarkers in the central nervous system
No standardized guidelines on the collection of CRP in the center
Potential presence of unaccounted confounders despite multivariable adjustments
Retrospective design with potential biases related to clinical recording and missing data
Single-center study limiting generalizability to other cohorts
Lack of long-term neurological assessment (limited to short-term 3-month outcomes)
Exclusion of early deaths (patients staying <24h in ICU)
No standardized guidelines on the collection timing of CRP

Implication

Elevated systemic inflammation biomarkers, particularly CRP, in the first 7 days after aneurysmal subarachnoid hemorrhage are independently associated with unfavorable neurological outcomes at 3 months.

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating condition that is associated with cerebral and systemic inflammation. C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLr) are easily available biomarkers of systemic inflammation. Therefore, we aimed to assess the impact of elevated CRP and NLr on aSAH outcomes. This retrospective, single-center study included adult patients admitted with aSAH to the intensive care unit (ICU) from January 2007 to December 2023. We recorded serum CRP and NLr levels during the first 7 days of ICU stay. An unfavorable neurological outcome at 3 months was defined as a Glasgow Outcome Scale (GOS) score of 1–3. A total of 547 patients were included in the study; 250 (45.7%) experienced unfavorable outcomes (UOs), and 140 (25.6%) developed delayed cerebral ischemia (DCI). Patients with unfavorable outcomes had higher levels of CRP from days 2 to 7 after SAH ( p = 0.001) and higher NLr ( p = 0.06) than those with favorable outcomes (FOs). In a multivariate logistic regression model, the highest CRP value (OR: 1.003, 95% CI: 1.001–1.005) and the highest NLr value (OR: 1.025; 95% CI: 1.001–1.050) in the first 7 days after SAH were independently associated with the occurrence of unfavorable outcomes. The highest NLr value was also associated with the development of DCI (sHR: 1.02, 95% CI: 1.01–1.03). In conclusion, high CRP and NLr values have a significant prognostic role in aSAH patients, reinforcing the importance of inflammation as a potential mechanism of secondary brain injury.

Discussion

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Cite This Study

Giovampaola et al. (2026) conducted a cohort in Aneurysmal subarachnoid hemorrhage (aSAH) (n=547). Elevated systemic inflammation biomarkers (CRP and NLr) vs. Lower levels of systemic inflammation biomarkers was evaluated on Unfavorable neurological outcome at 3 months (Glasgow Outcome Scale score of 1-3) (OR 1.003, 95% CI 1.001-1.005). The highest C-reactive protein (OR 1.003) and neutrophil-to-lymphocyte ratio (OR 1.025) values in the first 7 days after aneurysmal subarachnoid hemorrhage were independently associated with unfavorable neurological outcomes at 3 months.

synapsesocial.com/papers/6a10f5d7cfa01e990d9fe441 https://doi.org/10.3389/fneur.2026.1749871

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Association between systemic inflammation biomarkers and outcomes in patients with aneurysmal subarachnoid hemorrhage

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association between systemic inflammation biomarkers and outcomes in patients with aneurysmal subarachnoid hemorrhage

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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