Article
Elevation of Brain Natriuretic Peptide serum levels in patients with symptomatic Chronic Subdural Hematoma: preliminary results of an ongoing prospective study
Erhöhung des Brain Natriuretic Peptide Serumspiegels bei Patienten mit symptomatischen chronisch Subduralhämatomen: vorläufige Ergebnisse einer laufenden prospektiven Studie
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Authors
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Mehdi Chihi
- Department of Neurosurgery, University Hospital Essen, Germany
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Homajoun Maslehaty
- Department of Neurosurgery, Nordstadt Hospital Hannover, Germany
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Bernd-Otto Hütter
- Department of Neurosurgery, University Hospital Essen, Germany
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Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, Germany
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Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, Germany
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Karsten H. Wrede
- Department of Neurosurgery, University Hospital Essen, Germany
| Published: | June 26, 2020 |
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Outline
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Background: Brain Natriuretic Peptide (BNP) is a reliable biomarker for cardiac insufficiency. However, elevation of BNP serum levels in patients with other intracranial pathologies was also observed. The purpose of the current prospective study was to analyze BNP serum levels in patients with symptomatic chronic subdural hematoma (cSDH) and its clinical implication.
Methods: In this prospective study design, we included patients with cSDH, who underwent surgery at our department between November 2016 and October 2019. We excluded patients with recurrent bleedings, traumatic brain injury, cSDH associated with other intracranial pathologies and with a history of congestive heart failure, renal or endocrine disease, from analysis. We measured BNP serum levels pre- and postoperatively and at discharge. BNP values were analysed in view of the patients’ medical history and neurological condition. The BNP cutoff value was 35 pg/ml. The Glasgow coma score (GCS) and the modified Rankin scale (mRS) classified the clinical and the neurological condition at time of admission and discharge, respectively.
Results: We analyzed the data of 94 patients with cSDH (median age 76 years, male/female 3.5:1). The BNP-level in serum was preoperatively elevated in 68.1% of the patients (n=64; median=104.7 pg/ml; range 35.3 – 546.7 pg/ml; p<0.01). The serum levels increased after surgery (p<0.001) and decreased in the continuing course (p<0.001), reaching the preoperative level at discharge. Indeed, BNP serum levels at discharge did not significantly differ from the preoperative levels (p=0.202). Preoperative BNP levels showed a further significant statistical association with patient’s age, sex, presence of atrial fibrillation (AF) and antiplatelet and/or anticoagulant therapy (AAT) (p<0.01), but not with GCS and mRS at admission.
Conclusion: Our preliminary results showed a statistically significant elevation of BNP serum levels in patients with symptomatic cSDH. Moreover, BNP serum levels were significantly higher in females, old patients and in patients with AF and/or receiving AAT. Whether preoperative BNP serum levels can predict functional outcome of patients with symptomatic cSDH is part of this ongoing prospective study.
