Clinical Significance of Elevated Natriuretic Peptide Levels and Cardiopulmonary Parameters After Subarachnoid Hemorrhage

Nakamura, Tatsuya; Okuchi, Kazuo; Matsuyama, Tomohiro; Fukushima, Hidetada; Seki, Takahiro; Konobu, Toshifumi; Nishio, Kenji

doi:10.2176/nmc.49.185

Cited by 11 publications

(17 citation statements)

References 31 publications

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“…Earlier studies have indicated that brain ischemia is associated with the increase of BNP. 13,19,20,22 Nakamura et al 15 described that BNP is higher in unconscious SAH patients than in awake patients. Brain ischemia appears several days after the bleeding as delayed ischemic neurological deficits, which could be associated with the BNP increase.…”

Section: Discussionmentioning

confidence: 99%

Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage

Nyberg¹,

Karlsson

Ronne-Engström³

2014

JNS

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RuptuRe of an intracranial aneurysm is followed by an acute phase with a complex chain of events. Most obvious are the intracranial complications of clots, hydrocephalus, and brain ischemia in various degrees and combinations. Many patients also show serious systemic complications, probably as a result of the intracranial pathophysiology. It is generally thought that a main trigger for systemic changes is the increase in the intracranial pressure that occurs at the time of aneurysm rupture. The elevated intracranial pressure decreases cerebral blood flow and causes a transient or permanent global ischemia. A major stress reaction follows, including the release of adrenocorticotropic hormone, cortisol, Object. The rupture of an intracranial aneurysm is followed by increased intracranial pressure and decreased cerebral blood flow. A major systemic stress reaction follows, presumably to restore cerebral blood flow. However, this reaction can also cause adverse effects, including myocardial abnormalities, which are common and can be serious, and increased levels of natriuretic peptides, especially brain natriuretic peptide (BNP). The association of BNP with fluid and salt balance, vasospasm, brain ischemia, and cardiac injury has been studied but almost exclusively regarding events after admission. Brain natriuretic peptide has also been measured at various time points and analyzed in different ways statistically. The authors approached BNP measurement in a new way; they used the calculated area under the curve (AUC) for the first 4 days to quantitatively measure the BNP load during the first critical part of the disease state. Their rationale was a suspicion that early BNP load is a marker of the severity of the ictus and will influence the subsequent course of the disease by disturbing the fluid and salt balance.Methods. The study included 156 patients with acute spontaneous subarachnoid hemorrhage (SAH). Mean patient age was 59.8 ± 11.2 years, and 105 (67%) of the patients were female. An aneurysm was found in 138 patients. A total of 82 aneurysms were treated by endovascular coiling, 50 were treated by surgery, and 6 were untreated. At the time of admission, serum samples were collected for troponin-I analysis and for the N-terminal prohormone of BNP (NT-proBNP); daily thereafter, samples were collected for the NT-proBNP analysis. The cumulative BNP load was calculated as the AUC for NT-proBNP during the first 4 days. The following variables were studied in terms of their influence on the AUC for NT-proBNP: sex, age, World Federation of Neurosurgical Societies grade of SAH, Fisher grade, angiographic result, treatment of aneurysm, clinical neurological deterioration, verified infections, vasospasm treatment, and 6-month outcome.Results. The AUC for NT-proBNP was larger when variables indicated a more severe SAH. These variables were higher Fisher and World Federation of Neurosurgical Societies grades, high levels of troponin-I at admission, an aneurysm, neurological deficits, and infections. The AUC for NT-proBN...

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Section: Discussionmentioning

confidence: 99%

Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage

Nyberg¹,

Karlsson

Ronne-Engström³

2014

JNS

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“…We found a significant association of MR-proANP serum concentrations with poor outcome and mortality in SAH and ICH patients. Natriuretic peptides have been shown to be elevated in patients with SAH and have been found to be associated with a decreased level of consciousness [17,18]. Data from experimental studies suggest that cerebral ischemia induces ANP release [6,7].…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Value of Midregional Proatrial Natriuretic Peptide in Patients with Hemorrhagic Stroke

et al. 2014

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Background: Atrial natriuretic peptide (ANP) is a well-known prognostic marker of outcome and mortality in patients with cardiovascular disease. Midregional proatrial natriuretic peptide (MR-proANP) is a stable fragment of the ANP precursor hormone. As a prognostic marker after ischemic stroke, it reliably predicts poststroke mortality and functional outcome. This study aimed to analyze the prognostic value of MR-proANP in patients with hemorrhagic stroke, i.e. subarachnoid (SAH) and intracerebral hemorrhage (ICH). Methods: MR-proANP was analyzed in patients with spontaneous SAH or spontaneous ICH. All patients were prospectively randomized into two treatment arms: (1) a prophylactic normothermia group with a target core temperature 36.5°C using endovascular cooling, and (2) a control group with conventional stepwise predefined fever management using antipyretic medication and surface cooling. Blood samples were obtained on admission and on days 4 and 7. Measurement of MR-proANP was performed in serum using sandwich immunoassay. The primary endpoint was functional outcome [assessed by the Glasgow Outcome Score (GOS)] and the secondary endpoints were mortality within 180 days after hemorrhagic stroke and influence of temperature on MR-proANP. A favorable outcome was defined as GOS 4-5, and the patients were considered to have a poor outcome with a 180-day GOS score between 1 and 3. Results: Analysis of MR-proANP was performed in 24 patients with spontaneous SAH and 22 patients with spontaneous ICH. MR-proANP was elevated on days 4 and 7 as compared to baseline levels (p < 0.05 and p < 0.001, respectively). High MR-proANP levels (>120 pmol/l) were associated with increased mortality and poor outcome (after 180 days; p < 0.05, respectively). There was no significant difference regarding MR-proANP serum concentrations between the endovascular and the control groups. Conclusions: Increased levels of MR-proANP are independently associated with poor functional outcome and increased mortality after 180 days in patients with hemorrhagic stroke. Endovascular temperature control had no significant influence on MR-proANP levels.

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“…Nakamura et al reported a positive correlation between BNP and pulmonary extravascular water content in SAH patients with consciousness disturbance (22).…”

Section: Resultsmentioning

confidence: 99%

Analysis of the serum components in acute period after subarachnoid hemorrhage

Tykocki¹,

Kostyra²,

Bojanowski³

et al. 2014

Turkish Neurosurgery

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AIm: Multi-profile monitoring of various blood serum factors during acute subarachnoid haemorrhage (SAH) is crucial for successful treatment. The aim of the study is to evaluate the serum concentration of different blood factors in the acute period of SAH. mATERIAL and mETHods: 31 patients with confirmed aneurysmal SAH were enrolled in a prospective study. The concentrations of the following serum compounds were assessed on the day of admission and reassessed after 5 days: lipids profile, cardiac functionality enzymes and markers, electrolytes, osmolality, CRP (C-reactive protein), glucose, creatinine, urine. REsuLTs:The mean level of high-density lipoprotein (HDL) changed significantly from 43.9±23.9 mg/dL to 27.5±19,8 mg/dL, p=0,013 (mean dif. 16.5±14,1 mg/dL; 37,3%). Concentration of low-density lipoprotein (LDL) decreased by 28.6% (mean dif. 26.78±61.32; p=0.047). Values of triglicerydes and total cholesterol did not differ significantly between the initial evaluations and these repeated after 5 days. The overall serum ions (Na) concentrations and osmolality did not differ significantly between the initial measurements and after 5 days from SAH. The only mean value that appeared to be substantially increased at initial measurement was NT-proBNP and reached 1928.8±4952 pg/ ml, this value dropped down to 392.87±1147.9 mg/ml after 5 days (mean dif. 1535.96±4808.76 pg/ml; 79,6%; p = 0.247). CRP increased over 2 fold after 5 days up to 29.267±28.614 mg/L (mean dif. 16.06±34.05 pg/L; 121.6%; p=0.028). At 5-day follow up hematocrit dropped to 33.38 ± 3.81% from the initial value of 39.63 ± 2,56% (p=0.02). CoNCLusIoN:This study showed a significant decrease in the serum level of LDL and HDL, while triglycerides were moderately heightened. Routine monitoring of lipid profile and statin administration at the early stage of SAH is recommended.KEywoRds: Subarachnoid haemorrhage, Aneurysm, Lipids, Electrolytes, Cardiac enzymes ÖZ AmAÇ: Akut subaraknoid kanama (SAK) sırasında çeşitli kan serumu faktörlerinin çoklu profille izlenmesi başarılı bir tedavi için çok önemlidir. Çalışmanın amacı, SAK'nın akut döneminde farklı kan faktörlerinin serum konsantrasyonunu değerlendirmektir. yÖNTEm ve GEREÇLER: Bu prospektif çalışmaya teyit edilmiş anevrizmal SAK durumu olan 31 hasta alındı. Aşağıdaki serum bileşiklerin konsantrasyonları hastaneye yatma gününde ve 5 gün sonra değerlendirildi: lipid profili, kardiyak fonksiyon enzimleri ve belirteçleri, elektrolitler, ozmolalite, CRP (C-reaktif protein), glukoz, kreatinin. Ayrıca idrar tahlili yapıldı.BuLGuLAR: Yüksek dansiteli lipoprotein (HDL) ortalama seviyesi 43,9±23,9 mg/dL'den 27,5±19,8 mg/dL'ye önemli ölçüde değişti ( p=0,013) (ortalama fark 16,5±14,1 mg/dL; %37,3). Düşük yoğunluklu lipoprotein (LDL) konsantrasyonu %28,6 düştü (ortalama fark 26,78±61,32; p=0,047). Trigliserid ve total kolesterol değerleri açısından ilk değerlendirme ve 5 gün sonra tekrarlananlar arasında anlamlı farklılık yoktu. Genel serum iyon (Na) konsantrasyonları ve ozmolalite açısından ilk değerlend...

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Clinical Significance of Elevated Natriuretic Peptide Levels and Cardiopulmonary Parameters After Subarachnoid Hemorrhage

Cited by 11 publications

References 31 publications

Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage

Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage

The Prognostic Value of Midregional Proatrial Natriuretic Peptide in Patients with Hemorrhagic Stroke

Analysis of the serum components in acute period after subarachnoid hemorrhage

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