Observational studyJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2020
Elevated Cerebrospinal Fluid Protein Is Associated with Unfavorable Functional Outcome in Spontaneous Subarachnoid Hemorrhage.
Observational study in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
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Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.
- Cerebrospinal fluid predictors of shunt-dependent hydrocephalus after hemorrhagic stroke: a systematic review and meta-analysis.Neurosurgical review · 2022Pooled it
- Guillain-Barré syndrome following intracranial hemorrhage: a systematic review of case reports.Frontiers in neurologyPooled it
- A Longitudinal Imaging and Clinical Data Workflow Identifies Potential Time-Dependent Risk Factors for Post-Subarachnoid Hemorrhage Epilepsy.Neurocritical care · 2026Article
- Elevated cerebrospinal fluid protein predicts lumbar drainage catheter occlusion in neurosurgical patients.Neurosurgical review · 2025Article
- Cerebrospinal fluid analysis and changes over time in patients with subarachnoid hemorrhage: a prospective observational study.Journal of anesthesia, analgesia and critical care · 2025Article
- Ventriculosagittal sinus shunt for treating hydrocephalus with elevated cerebrospinal fluid protein.Fluids and barriers of the CNS · 2025Article
- Temporal Changes in CSF Cell Parameters After SAH: Comparison of Ventricular and Spinal Drain Samples.Neurocritical care · 2024Article
- Longitudinal ventricular cerebrospinal fluid profile in patients with spontaneous subarachnoid hemorrhage.Frontiers in neurology · 2022Article
- Inflammasome Caspase-1 Activity is Elevated in Cerebrospinal Fluid After Aneurysmal Subarachnoid Hemorrhage and Predicts Functional Outcome.Neurocritical care · 2021Article
Corrections and comments
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Authors and funding
9 authors at 1 institution in 2 countries.
Funding
Abstract
BACKGROUND/
objectiveSubarachnoid hemorrhage (SAH) is a devastating neurologic event for which markers to assess poor outcome are needed. Elevated cerebrospinal fluid (CSF) protein may result from inflammation and blood-brain barrier (BBB) disruption that occurs during SAH. We sought to determine if CSF protein level is associated with functional outcome after SAH.
methodsWe prospectively collected single-center demographic and clinical data for consecutive patients admitted with spontaneous SAH. Inclusion required an external ventricular drain and daily CSF protein and cellular counts starting within 48 hours of symptom onset and extending through 7 days after onset. Seven-day average CSF protein was determined from daily measured values after correcting for contemporaneous CSF red blood cell (RBC) count. Three-month functional outcome was assessed by telephone interview with good outcome defined as modified Rankin score 0-3. Variables univariately associated with outcome at P less than .25 and measures of hemorrhage volume were included for binary logistic regression model development.
resultsThe study included 130 patients (88% aneurysmal SAH, 69% female, 54.8 ± 14.8 years, Glasgow Coma Scale [GCS] 14 [7-15]). Three-month outcome assessment was complete in 112 (86%) patients with good functional outcome in 74 (66%). CSF protein was lower in good outcome (35.3 [20.4-49.7] versus 80.5 [40.5-115.5] mg/dL; P < .001). CSF protein was not associated with cerebral vasospasm, but delayed radiographic infarction on 3 to 12-month neuroimaging was associated with higher CSF protein (46.3 [32.0-75.0] versus 30.2 [20.4-47.8] mg/dL; P = .023). Good 3-month outcome was independently associated with lower CSF protein (odds ratios [OR] .39 [.23-.70] for 75th versus 25th percentile of protein; P = .001) and higher admission GCS (OR 1.23 [1.10-1.37] for good outcome per GCS point increase; P < .001). Parenchymal hematoma predicted worse outcome (OR 6.31 [1.58-25.25]; P = .009). Results were similar after excluding nonaneurysmal SAH and after including CSF RBC count, CT score, and intraventricular hemorrhage volume in models.
conclusionsElevated average CSF protein is associated with poor outcome after spontaneous SAH. Further research should investigate if elevated CSF protein identifies patients in whom mechanisms such as BBB disruption contribute to poor outcome.
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