Article
Analysis of brain natriuretic peptide serum levels in aneurysmatic subarachnoid haemorrhage and their relationship with delayed cerebral ischemia
Analyse der Brain natriuretic peptide Serumspiegel bei aneurysmatischer Subarachnoidalblutung und deren Zusammenhang mit der verzögerten zerebralen Ischämie
Search Medline for
Authors
Published: | May 25, 2022 |
---|
Outline
Text
Objective: The role of brain natriuretic peptide (BNP) serum levels on admission in the prediction of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) remains to date controversial. Prospective data are lacking and secretion pattern of BNP after aSAH is still unknown. This study aimed therefore to prospectively assess BNP levels and investigate their relation to DCI.
Methods: Patients with aSAH who were admitted in the authors' institution between July 2016 and June 2021 and who initially did not have any history of chronic heart/kidney failure were enrolled in this prospective observational study. BNP was measured at admission. Time between ictus and BNP sampling (TIS) was assessed in hours (h), then split in five categories (<3h, 3-6h, 6-12h, 12-24h, and ≥24h). Admission variables including patients' clinical (Hunt-Hess, World Federation of Neurosurgical Surgeons, and Fisher grading scales) and radiographic (acute hydrocephalus, intracerebral [ICH], and intraventricular [IVH] hemorrhages) characteristics as well as the occurrence of DCI and cerebral vasospasm (CVS) were documented.
Results: In total, 169 patients were included (median age: 57 years). Median BNP was in the TIS-categories 42.0, 44.2, 48.9, 120.4, and 97.9 pg/ml, respectively. A statistically significant increase in median BNP was observed at a TIS-cutoff=12h (101.6 vs. 44.4 pg/ml, p=0.0005). Individuals with higher aSAH burden (Fisher grades 3/4=60.1 vs. grades 1/2=31.3 pg/ml, p=0.036), acute hydrocephalus (67.5 vs. 44.3 pg/ml, p=0.043), and IVH (64 vs. 46.5 pg/ml, p=0.068) showed higher BNP levels at admission. After adjusting for several confounders (age, comorbidities, and TIS), a hierarchical multiple regression showed that IVH (p=0.042) was an independent predictor of BNP increase. Finally, no statistical association was found between BNP and DCI/VCS.
Conclusion: In patients with aSAH, BNP levels rise from a TIS of 12h and this increase seems to be related to IVH. Interestingly, no association was observed between BNP at admission and DCI risk after aSAH.