An observational study of the association between microalbuminuria and increased N-terminal pro-B-type natriuretic peptide in patients with subarachnoid hemorrhage

Abstract

BackgroundThe urinary albumin/creatinine ratio (ACR) is a significant neurologic prognostic predictor in patients with aneurysmal subarachnoid hemorrhage (SAH). B-type natriuretic peptide (BNP) plays an important role in body fluid regulation in patients with SAH. The present study was performed to determine whether ACR was independent predictor for unfavorable neurological outcome and ACR was associated with increased N-terminal pro-BNP (NT-pro-BNP) after SAH.MethodsWe studied 61 patients undergoing surgery who were admitted within 48 h after aneurysmal SAH onset between July 2008 and June 2010. Hunt and Hess grade and Fisher grade were recorded at admission. The Glasgow Coma Scale (GCS) score was calculated at admission and daily for seven postoperative days. Arterial blood was sampled at admission and for seven postoperative days to determine the PaO2/FIO2 ratio, C-reactive protein level, troponin I level, and NT-pro-BNP level. Urine was sampled at admission and daily for seven postoperative days to determine ACR and vanillylmandelic acid/creatinine ratio (VMACR). Neurological outcomes were assessed at hospital discharge by using the Glasgow Outcome Scale. Receiver operating characteristic curves were constructed for the predictive variables of unfavorable neurological outcomes, and the area under the curve (AUC) was determined. Multivariate logistic regression analyses were performed for the significant predictors of unfavorable neurological outcomes after SAH. Associations with NT-pro-BNP were evaluated by using the Spearman rank correlation test.ResultsOf the 61 patients, 24 had unfavorable outcomes. The prevalence rate of microalbuminuria was 85 % (52/61). The highest NT-pro-BNP levels were above the normal range in 57 of 61 patients (93 %).According to the AUC, the Hunt and Hess grade, GCS score, the highest ACR, and highest VMACR were significant predictors of neurological outcome. Multivariate logistic regression analyses showed that the highest ACR and Hunt and Hess grade are independent prognostic predictors of unfavorable neurological outcomes. The highest NT-pro-BNP significantly correlated with the highest troponin I, highest ACR, and VMACR on admission.ConclusionsThe highest ACR is an independent prognostic predictor of unfavorable neurological outcomes after SAH. Moreover, plasma NT-pro-BNP elevation may be associated with the development of microalbuminuria.

N-Terminal Pro-Brain Natriuretic Peptide Concentrations After Hypertensive Intracerebral Hemorrhage: Relationship With Hematoma Size, Hyponatremia, and Intracranial Pressure

“…The NT-proBNP has been previously considered as a predictive biomarker for diagnosis and prognosis of patients with cardiovascular disease, such as left ventricular dysfunction, systolic and diastolic dysfunction, and acute coronary syndromes. [13][14][15] Recently, some studies showed that elevation in NT-proBNP was common in patients hospitalized with ischemic stroke, SAH, and ICH, as well as TBI, [3][4][5][6][7][8][9]16 suggesting that NT-proBNP might play a role after acute brain injury. However, the change pattern of NT-proBNP after isolated HICH was barely reported.…”

“…Recent studies have demonstrated that the levels of serum BNP or N-terminal pro-BNP (NT-proBNP), a circulating precursor of BNP, increased during the acute phase of cerebral lesions such as traumatic brain injury (TBI), 3 ischemic stroke, [4][5][6] and subarachnoid hemorrhage (SAH). [7][8][9] The increased plasma BNP levels might be the main cause of cerebral salt wasting syndrome, which is characterized by hyponatremia and natriuresis after SAH. 7 However, the role of NT-proBNP in HICH is poorly understood, and the relationship between NT-proBNP and hyponatremia, which could lead to malignant brain edema and elevation in intracranial pressure (ICP), is still a controversial issue.…”

Albuminuria: An Underappreciated Risk Factor for Cardiovascular Disease

“… 70 The UACR is also a significant neurologic prognostic predictor in patients with aneurysmal subarachnoid hemorrhage; the mechanism of association between the 2 disorders is not known. 71 Microalbuminuria is also a prognostic marker of cardiopulmonary complications after major surgery. However, its independent prognostic significance remains to be established.…”