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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Brain natriuretic peptide serum levels in aneurysmatic subarachnoid haemorrhage and the prediction of functional outcome

Brain natriuretic peptide Serumspiegel bei aneurysmatischer Subarachnoidalblutung und die Vorhersage des funktionellen Outcomes

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  • presenting/speaker Mehdi Chihi - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Marvin Darkwah Oppong - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Thiemo F. Dinger - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Oliver Gembruch - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Laurèl Rauschenbach - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Christoph Rieß - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Meltem Gümüs - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Bixia Chen - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Annika Lenkeit - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Philipp Dammann - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Karsten H. Wrede - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV240

doi: 10.3205/22dgnc232, urn:nbn:de:0183-22dgnc2326

Published: May 25, 2022

© 2022 Chihi 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: Brain natriuretic peptide (BNP) serum levels on admission have been implemented in the prediction of functional outcomes of several cerebrovascular diseases. The potential role of BNP in the prediction of outcomes after aneurysmatic subarachnoid hemorrhage (aSAH) has not yet been addressed. This study aimed to elucidate that relationship.

Methods: The authors enrolled a prospective cohort of patients in the study who were admitted between July 2016 and June 2021 in their own institution. Patients with a history of chronic heart/kidney failure were excluded. BNP levels were measured at admission. Patients' clinical (Hunt-Hess, [HH] World Federation of Neurosurgical Surgeons [WFNS], and Fisher grading scales) and radiographic (acute hydrocephalus, intracerebral [ICH], and intraventricular [IVH] hemorrhages) characteristics, as well as outcome-relevant variables such as cerebral vasospasm (CVS), delayed cerebral ischemia (DCI), re-bleeding before therapy, decompressive craniectomy (DC), and time between ictus and therapy were documented. Functional outcomes were assessed at follow-up (3 months) using the modified Rankin scale (mRS). A mRS >3 was considered a poor outcome.

Results: Altogether, 169 patients were included (median age: 57 years). Patients had higher HH (4/5), WFNS (4/5), and Fisher (3/4) grades in 43.8% (n=74), 48.5% (n=82), and 84.6% (n=143), respectively. Poor functional outcomes at follow-up were statistically significantly associated with age ≥75 years (p=0.009), higher HH (p=0.0005), WFNS (p=0.0005), and Fisher (p=0.0005) grading scales, ICH (p=0.003), IVH (p=0.0005), and acute hydrocephalus (p=0.001), DCI (p=0.010) and CVS (p=0.004), DC (p=0.0005) and higher BNP levels (p=0.002). After adjusting with several confounders, hierarchical binomial logistic regression showed that BNP was, amongst others, an independent predictor of functional outcome at follow-up (p=0.007).

Conclusion: High BNP levels on admission could predict a poor outcome at follow-up. Further prospective studies should focus on explaining this yet not well-understood brain-heart crosstalk where BNP elevation merely represents the tip of the iceberg.