Article
Brain natriuretic peptide as predictor of early postoperative seizure in patients with traumatic acute subdural hematoma – a prospective study
Brain natriuretic Peptide als Prädiktor der früh postoperativen Krampfanfälle nach chirurgischer Behandlung traumatischer akuter Subduralhämatome – eine prospektive Studie
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Published: | June 4, 2021 |
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Objective: Brain natriuretic peptide (BNP) is known as a reliable biomarker in the acute phase of traumatic brain injury, related to its severity, presence of increased intracranial pressure and unfavorable outcome. The purpose of this study was to analyze the plasma BNP level in patients with traumatic acute subdural hematoma (aSDH) and assess its clinical implications.
Methods: Patients with unilateral traumatic aSDH that were surgically treated in our department between July 2017 and April 2020 were included in the study. Plasma BNP levels were preoperatively measured. Early postoperative seizure (EPS) was assessed. Neurological condition and functional status of the patients were prospectively recorded using the Glasgow Coma Scale (GCS) at admission, at the seventh postoperative day, and the modified Rankin Scale (mRS) at discharge and follow-up (at 2-3 months), respectively. An unfavorable outcome was defined by a mRS>3.
Results: In total, 104 patients were included in the study (median age: 74.5 years, range: 23-91 years). In-hospital mortality occurred in 31.7% of the cases (n=33). At follow-up, 83.1% of the survivors were assessed. EPS (median: 3 days, IQR: 1 day) occurred in 19.2% of the patients (n=20), and was recurrent in 80% (16/20) of the cases. The univariate analysis showed a statistically significant association between poor GCS score at the seventh postoperative day and EPS, but no association between EPS and functional outcome at discharge and last follow-up. The multivariate analysis revealed higher plasma BNP levels (cutoff ≥ 95.4 pg/ml, aOR=5.9, p=0.004), left-sided aSDH (aOR=4.4, p=0.017) and female sex (aOR=3.8, p=0.024) as independent predictors of EPS.
Conclusion: Preoperative plasma BNP level is a reliable predictor of EPS in patients with traumatic aSDH. EPS is common and is known to worsen the postoperative neurological status of the patients, affecting the short and long-term functional outcome by delaying the recovery. Whether the postoperative prophylactic use of antiepileptic drugs in patients with higher risk of EPS can improve their neurological and functional outcome, needs further investigations.