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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Adrenomedullin as a biomarker for severity of aneurysmal subarachnoid haemorrhage and delayed cerebral ischemia

Adrenomedullin als Biomarker für den Schweregrad einer aneurysmatischen Subarachnoidalblutung und delayed cerebral ischemia

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  • presenting/speaker Michael Veldeman - Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Tim Phillip Simon - Universitätsklinikum Aachen, Operative Intensivmedizin, Aachen, Deutschland
  • Rabia Dogan - Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Miriam Weiss - Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Christian Stoppe - Universitätsklinikum Aachen, Operative Intensivmedizin, Aachen, Deutschland
  • Gernot Marx - Universitätsklinikum Aachen, Operative Intensivmedizin, Aachen, Deutschland
  • Hans Clusmann - Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Gerrit Alexander Schubert - Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV038

doi: 10.3205/21dgnc040, urn:nbn:de:0183-21dgnc0408

Published: June 4, 2021

© 2021 Veldeman et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Adrenomedullin (ADM) is a potent vasodilator which has been identified as a promising marker of mortality and outcome in sepsis, heart failure and after major surgery. A recently developed assay specific for biologically active (bio-ADM) has not yet been assessed in patients suffering aneurysmal subarachnoid hemorrhage (aSAH). The objective of this prospective trial was to assess the time course of bio-ADM after aSAH in relation to the development of delayed cerebral ischemia (DCI) and clinical outcome.

Methods: Plasma levels of adrenomedullin were measured daily in 31 aSAH patients. Clinical and radiological severity was assessed by the Hunt and Hess (H&H) and modified Fisher (mFisher) grading scales, respectively. DCI was diagnosed clinically or based on CT perfusion imaging, and the occurrence of DCI-related cerebral infarction, as a result of treatment failure, was noted. Overall mortality was registered alongside clinical outcome after 12 months defined by the extended Glasgow Outcome scale (GOSE).

Results: Delayed cerebral ischemia was diagnosed in 14 (45.2 %) cases of which 7 (22.6 %) developed DCI-related cerebral infarction. Initial ADM levels were representative of clinical (H&H, p = 0.024) and radiological (mFisher; p = 0.012) aSAH severity. No significant differences in ADM levels before and after diagnosing DCI were noted (p = 0.889). After day four, ADM levels were higher in patients who developed DCI-related infarction (0.002) or died during hospitalization (p = 0.030). Favorable outcome (GOSE5-8) was noted in 13 (41.9 %) cases after 12 months. In multivariate analysis, only poor H&H (p < 0.001) and modified Fisher grading (p = 0.004) were associated with a decreased likelihood of achieving favorable outcome, but not ADM levels (p = 0.493).

Conclusion: Initial early ADM levels reflect the severity of aSAH but did not have predictive value on long-term clinical outcome. However, ADM levels were higher in patients who later developed DCI-related cerebral infarction or died during their hospital stay.