Article
Predictors of brain natriuretic peptide increase in traumatic acute subdural haematoma and its role in the prediction of postoperative cerebral infarction
Prädiktoren des BNP-Anstiegs bei traumtischem akuten Subduralhämatom und seine Rolle in der Prädiktion der früh-postoperativen zerebralen Ischämie
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Published: | June 4, 2021 |
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Objective: The increase of plasma brain natriuretic peptide (BNP) concentrations on admission was demonstrated in patients with traumatic brain injury (TBI), but has been not yet addressed in traumatic acute subdural hematoma (aSDH). The aim of this study was to assess the relationship between plasma BNP levels and radiological findings in patients treated for traumatic aSDH.
Methods: Patients with unilateral traumatic aSDH that were admitted in our department between July 2017 and April 2020 were enrolled in the study. Plasma BNP level was measured at admission. Time between trauma and BNP sampling (TTS) was assessed. Admission radiographic variables included hematoma volume (Hem-Vol, using a computer-assisted volumetric analysis) , middle line shift, presence of intracerebral contusions, and brain edema (using SEBES). In the subgroup with aSDH surgery, radiographic evaluation was enhanced with postoperative cerebral infarction, new cerebral contusions and re-bleeding. BNP cutoff-value was assessed using the area under the curve of the receiver operating characteristic analysis.
Results: In total, 130 patients were included in the study (median age: 74.5 years). Surgical treatment was performed in 82.3% (n=107) cases, 14.6% (n=19) were conservatively treated, and only 3.1% (n=4) were not operated because of worse prognosis. Higher plasma BNP levels on admission were statistically significantly associated with longer TTS, higher Hem-Vol and lower SEBES. After adjusting for age and sex, multiple regression analysis showed that Hem-Vol (p=0.044) and advanced age (p=0.0005) were independent predictors of increased plasma BNP levels on admission. In contrast, lower plasma BNP levels were associated with postoperative early cerebral infarction (median: 3 days). Binomial logistic regression showed that preoperative plasma BNP level (cutoff <29.4, aOR=16.5, p=0.023) was an independent predictor of postoperative cerebral infarction when TTS=3-12h.
Conclusion: In patients with aSDH, BNP increase is related to aSDH volume and advanced age. Interestingly, there is a higher risk of postoperative cerebral infarction in aSDH individuals who showed low preoperative BNP values at 3-12h post-trauma.