High-sensitivity C-reactive protein as a predictive factor of acute kidney injury following aneurysmal subarachnoid hemorrhage: a prospective observational study
Authors: Qing-Xi Tang
De-Zhi Kang
Bi-Hui Yang
Qiu He
Chen-Yu Ding
Journal: Acta Neurochirurgica (2019)
Discipline: CLINICAL MEDICINE
Keywords: Acute kidney injury; Aneurysmal subarachnoid hemorrhage; High-sensitivity C-reactive protein.
Affiliations: Department of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China., Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China., Department of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China. .

Abstract:  Background: 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. Methods: 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. Results: 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 &gt; 6.6 mg/L had a significantly higher AKI rate than patients having serum hs-CRP level ≤ 6.6 mg/L (P = 0.001). Conclusions: 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. 

Retracted: No

PubPeer comments:
 Table 1 was pointed out to me by a reader. * In the Hydragogue row, the numbers (6 in AKI group) and 38 in Non-AKI group) do not add up to 66 (Total). ![file] , 
 Figure 2. * The text states:  Post hoc log-rank testing revealed that patients having serum hs-CRP 6.6 mg L had a significantly higher rate of AKI than those having hs-CRP u2264 6.6 mg L (20% (13 65) vs. 4.0% (4 99), P = 0.001) The Figure appears to show the opposite. ![file] , 
 #1 Hi, Elisabeth M Bik Thank you for raising this concern. Although we have the original data and they fully support the results, we sincerely apologize for this unintentional clerical error made before manuscript submission but we failed to catch at the submission and subsequent review and publication steps. Statistical analysis was performed with SPSS17.0. And for some simple calculations, we also use calculators. We calculated this result (Hydragogue row, n=66) with a calculator, 44 was incorrectly entered as 66. Hydragogue was no a significant factor between two groups, this error has no bearing on the presented results. We regret that we accidentally error occurred while calculating. We will contact the editorial office of Acta Neurochirurgica and try to make correction as soon as possible. , 
 #2 Thank you for raising this concern. We sincerely apologize for this unintentional clerical error made before manuscript submission but we failed to catch at the submission and subsequent review and publication steps. Statistical analysis was performed with SPSS17.0. In order to make the figure looking cleaner and nicer, we added comment labels used PPT instead of the ones that come with the SPSS software. We regret that the accidentally error occurred while adding labels (They re labeled opposite). We will contact the editorial office of Acta Neurochirurgica and try to make correction as soon as possible. The authors apologize for the inconvenience caused by these errors. Thanks again for your valuable concerns. , 
 Correction, February 2021: https: link.springer.com article 10.1007 s00701-021-04734-1  *In the article u201cHigh-sensitivity C-reactive protein as a predictive factor of acute kidney injury following aneurysmal subarachnoid hemorrhage: a prospective observational study,u201d the following is stated in the Table 1: u201cHydragogue 66 (40.2%)u201d . The n(%) should be u201c44 (26.8%)u201d.* *The labels u201cserum hs-CRP level u22646.6 mg Lu201d and u201cserum hs-CRP 6.6mg Lu201d were labeled opposite in Fig. 2. The label u201cserum hs-CRP levelu2009u2264u20096.6 mg Lu201d should be u201cserum hs-CRPu2009 u20096.6 mg Lu201d, and the label u201cserum hs-CRPu2009 u20096.6 mg Lu201d should be u201cserum hs-CRP u2264 6.6mg Lu201d.* I thank the authors and the journal for their quick reply and addressing these errors. ,