Vasopressin serum levels in patients with severe brain lesions and in brain-dead patients

Abstract

-Introduction: Patients with severe brain lesions (SBL) and brain-dead patients (BD) frequently present with vasopressin (AVP) secretion disorders. Objective: To evaluate AVP serum levels in SBL and BD patients. Design: Prospective, open label, observational trial. Setting: A general teaching hospital. Method:Three groups of adult subjects (age ≥ 18y) of both sexes were included in this study: control group: 29 healthy volunteers; SBL group: 17 patients with Glasgow Coma Scale (GCS) ≤8; and BD group: 11 brain-dead patients. Samples of venous blood were collected in the morning at rest from healthy volunteers and at 8 hourly intervals over a period of 24h from SBL and BD patients for AVP determinations. Concomitantly, some clinical and laboratorial variables were also recorded. Results: AVP serum levels (pg/ml) were [mean (SD); median]: control [2.2(1.1); 2.0]; SBL [5.7(6.3); 2.9]; and BD [2.6(1.0); 2.8]. AVP serum levels varied greatly in SBL patients, but without statistically significant difference in relation to the other groups (p=0.06). Hypotension (p=0.02), hypernatremia (p=0.0001), serum hyperosmolarity (p=0.0001) and urinary hypoosmolarity (p=0.003) were outstanding in BD patients when compared with SBL. Conclusions: The AVP serum levels did not demonstrate significant statistical difference between the groups, only showing a greater variability in SBL patients (manifested as serum spike levels). Hypernatremia and hyperosmolarity were present in BD patients, indicating a failure of the hypothalamic-pituitary system in AVP production and release.KEY WORDS: brain lesion, brain death, vasopressin. Níveis séricos de arginina vasopressina em pacientes com lesão cerebral grave e em pacientes com morte encefálicaRESUMO -Introdução: Pacientes com lesão cerebral grave (LCG) ou com morte encefálica (ME) freqüentemente apresentam alterações na secreção de vasopressina (AVP). Objetivo: Avaliar os níveis séricos de AVP em pacientes com LCG e ME. Desenho: Estudo prospectivo, aberto, observacional. Local: Um hospital geral universitário. Método: Sujeitos adultos (idade ≥18 anos), de ambos os sexos, foram divididos em três grupos: grupo controle: 29 voluntários sadios; grupo LCG: 17 pacientes com pontuação na Escala de Coma de Glasgow (ECG) ≤8; grupo ME: 11 pacientes com diagnóstico de ME.Amostras de sangue venoso foram colhidas pela manhã, em repouso, nos pacientes do grupo controle, e de 8/8h, por 24h, nos pacientes dos grupos LCG e ME, para dosagens de AVP. Variáveis clínicas e laboratoriais de interesse foram anotadas concomitantemente. Resultados: Os valores da AVP (pg/ml) foram [média (DP); mediana]: grupo controle [2,2(1,1); 2,0]; grupo LCG [5,7(6,3); 2,9] e grupo ME [2,6(1,0); 2,8]. Observouse maior variação dos níveis séricos de AVP no grupo LCG, mas sem diferença estatisticamente significativa em relação aos demais (p=0,06). Hipotensão (p=0,02), hipernatremia (p=0,0001), hiperosmolaridade sérica (p=0,0001) e hiposmolaridade urinária (p=0,003) foram proeminentes no grupo ME em relação ao grupo LCG. Con...

Vasopressina plasmática em pacientes submetidos à correção de aneurisma de aorta infrarrenal

“…Chen et al [21] reported plasma AVP levels varying from 2.2 to 8.0 pg/mL in normovolemic patients and normotensive patients, with serum osmolarity ≤ 290 mOsm/L. In a previous study of our group [22], plasma AVP values in 29 healthy adults individuals at rest were also very low (ranging from 0.4 to 5.2 pg/mL).= In the present investigation, preoperative (T0 -basal period) mean plasma AVP levels were of 1.37±0.73 pg/mL (median=1.34 pg/mL; range=0.30 -3.1 pg/mL), thus, inside those previously described by our group [22] in healthy resting adult individuals.…”

Role of Vasopressin V1a and V2 Receptors for the Development of Secondary Brain Damage after Traumatic Brain Injury in Mice

“…Most importantly, however, several experimental and clinical studies already demonstrated that vasopressin is involved in brain edema formation. Elevated vasopressin serum levels were found in patients suffering from brain edema due to brain tumors (Tenedieva et al, 1994), subarachnoidal hemorrhage (Mather et al, 1981), cerebral ischemia (Barreca et al, 2001), or TBI (Huang et al, 2003;Cintra et al, 2004). Although ICV or intravenous application of arginine vasopressin in experimental animals does not cause swelling of normal brain (Vajda et al, 2001), it increases brain edema formation following pathological conditions, for example, cortical cold lesion (Reeder et al, 1986) or cerebral ischemia (Liu et al, 1996).…”

“…Several studies indicate that patients with traumatic brain injury (TBI), subarachnoid hemorrhage, or cerebral ischemia have increased AVP levels in plasma and cerebrospinal fluid (Mather et al, 1981;Joynt et al, 1981;Cintra et al, 2004;Xu et al, 2007). Similarly, studies in rats showed an increased expression of V 1 receptor levels after experimental TBI (Szmydynger-Chodobska et al, 2004;Pascale et al, 2006).…”

Arginine Vasopressin V1a Receptor-Deficient Mice Have Reduced Brain Edema and Secondary Brain Damage following Traumatic Brain Injury

“…[38][39][40] Barreca and colleagues reported elevated serum AVP levels that were independent of osmo-and baro-mechanisms in post-ischemic human conditions. 41 In addition, elevated AVP levels in the cerebral spinal fluid (CSF) were found specifically in neurological disorders that have increased intracranial pressure.…”