Microalbuminuria is a prognostic predictor in aneurysmal subarachnoid hemorrhage
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To determine the prevalence and the prognostic significance of microalbuminuria in patients after aneurysmal subarachnoid hemorrhage (SAH).
Prospective and observational clinical study.
Multidisciplinary intensive care unit.
Fifty-one consecutive patients who underwent aneurysm clipping or endovascular surgery after SAH; 8 patients who underwent surgical clipping for unruptured intracerebral aneurysm served as control.
Measurements and Results
General clinical and neurological data were recorded on admission. Urine was collected preoperatively and daily for up to 7 days postoperatively for measuring the urinary microalbumin/creatinine ratio. The Glasgow Coma Scale (GCS) score was also determined on admission and daily for up to 7 days after operation. Neurological outcome was assessed using the Glasgow Outcome Scale (GOS) at 3 months after stroke.
The prevalence rates of microalbuminuria were 74.5% in SAH and 37.5% in the control. Among the 51 patients, 25 had unfavorable neurological outcome (GOS 1–3). The areas under the receiver operator characteristic curves showed that the highest urinary microalbumin/creatinine ratio and the lowest GCS score during the first 8 days were the significant predictors of unfavorable neurological outcome. The threshold value, sensitivity, specificity, and likelihood ratio for the highest urinary microalbumin/creatinine ratio were 200 mg/g, 60% [95% confidence interval (CI) 41–79], 96% (95% CI 88–100), and 15.6 (95% CI 9.1–26.7), respectively.
This study confirms a high prevalence of microalbuminuria in the SAH patients, and it suggests that the highest urinary microalbumin/creatinine ratio > 200 mg/g during the first 8 days is a significant predictor of unfavorable neurological outcome.
- Nakamura M, Onoda T, Itai K, Ohsawa M, Satou K, Sakai T, Segawa T, Sasaki J, Tonari Y, Hiramori K, Okayama A (2004) Association between serum C-reactive protein levels and microalbuminuria: a population-based cross-sectional study in northern Iwate, Japan. Intern Med 43:919–925 CrossRef
- Slowik A, Turaj W, Iskra T, Strojny J, Szczudlik A (2002) Microalbuminuria in nondiabetic patients with acute ischemic stroke: prevalence, clinical correlates, and prognostic significance. Cerebrovasc Dis 14:15–21 CrossRef
- Thorevska N, Sabahi R, Upadya A, Manthous C, Amoateng-Adjepong Y (2003) Microalbuminuria in critically ill medical patients: prevalence, predictors, and prognostic significance. Crit Care Med 31:1075–1081 CrossRef
- Rosen DS, Macdonald RL (2004) Grading of subarachnoid hemorrhage: modification of the World Federation of Neurosurgical Societies Scale on the basis of data for a large series of patients. Neurosurgery 54:566–576 CrossRef
- Claassen J, Kreiter KT, Kowalski RG, Du EY, Ostapkovich N, Fitzsimmons BFM, Connolly ES, Mayer SA (2004) Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage. Crit Care Med 32:832–838 CrossRef
- Terao Y, Takada M, Fujinaga A, Fukusaki M, Sumikawa K (2005) Microalbuminuria is a prognostic predictor in aneurysmal subarachnoid hemorrhage. Anesthesiology 103:A79
- De Gaudio AR, Adembri C, Grechi S, Novelli GP (2000) Microalbuminuria as an early index of impairment of glomerular permeability in postoperative septic patients. Intensive Care Med 26:1364–1368 CrossRef
- Mascia L, Fedorko L, terBrugge K, Filippini C, Pizzio M, Ranieri VM, Wallace MC (2003) The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage. Intensive Care Med 29:1088–1094 CrossRef
- Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20 CrossRef
- Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9 CrossRef
- Baggish AL, MacGillivray TE, Hoffman W, Newell JB, Lewandrowski KB, Lee-Lewandrowski E, Anwaruddin S, Siebert U, Januzzi JL (2004) Postoperative troponin-T predicts prolonged intensive care unit length of stay following cardiac surgery. Crit Care Med 32:1866–1871 CrossRef
- Gansevoort RT, Verhave JC, Hillege HL, Burgerhof JG, Bakker SJ, de Zeeuw D, de Jong PE; for the PREVEND Study Group (2005) The validity of screening based on spot morning urine samples to detect subjects with microalbuminuria in the general population. Kidney Int Suppl 94:S28–S35 CrossRef
- Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84 CrossRef
- Members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee (1992) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874 CrossRef
- Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484 CrossRef
- Weiss N, Sanchez-Pena P, Roche S, Beaudeux JL, Colonne C, Coriat P, Puybasset L (2006) Prognosis value of plasma S100B protein levels after subarachnoid aneurysmal hemorrhage. Anesthesiology 104:658–666 CrossRef
- Gruber A, Reinprecht A, Gorzer H, Fridrich P, Czech T, Illievich UM, Richling B (1998) Pulmonary function and radiographic abnormalities related to neurological outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg 88:28–37 CrossRef
- Yoshimoto Y, Tanaka Y, Hoya K (2001) Acute systemic inflammatory response syndrome in subarachnoid hemorrhage. Stroke 32:1989–1993
- Mogensen CE, Christensen CK (1984) Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med 311:89–93 CrossRef
- Mogensen CE (1984) Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 310:356–360 CrossRef
- Jager A, Kostense PJ, Ruhe HG, Heine RJ, Nijpels G, Dekker JM, Bouter LM, Stehouwer CDA (1999) Microalbuminuria and peripheral arterial disease are independent predictors of cardiovascular and all-cause mortality, especially among hypertensive subjects: five-year follow-up of the Hoorn study. Arterioscler Thromb Vasc Biol 19:617–624
- Guerrero-Romero F, Rodriguez-Moran M (1999) Proteinuria is an independent risk factor for ischemic stroke in non-insulin-dependent diabetes mellitus. Stroke 30:1787–1791
- Wartenberg KE, Schmidt JM, Claassen J, Temes RE, Frontera JA, Ostapkovich N, Parra A, Connolly ES, Mayer SA (2006) Impact of medical complications on outcome after subarachnoid hemorrhage. Crit Care Med 34:617–623 CrossRef
- Claassen J, Carhuapoma JR, Kreiter KT, Du EY, Connolly ES, Mayer SA (2002) Global cerebral edema after subarachnoid hemorrhage: frequency, predictors, and impact on outcome. Stroke 33:1225–1232 CrossRef
- Parekh N, Venkatesh B, Cross D, Leditschke A, Atherton J, Miles W, Winning A, Clague A, Rickard C (2000) Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage. J Am Coll Cardiol 36:1328–1335 CrossRef
- Crago EA, Kerr ME, Kong Y, Baldisseri M, Horowitz M, Yonas H, Kassam A (2004) The impact of cardiac complications on outcome in the SAH population. Acta Neurol Scand 110:248–253 CrossRef
- Molnar Z, Szakmany T, Heigl P (2003) Microalbuminuria does not reflect increased systemic capillary permeability in septic shock. Intensive Care Med 29:391–395 CrossRef
- Dziedzic T, Slowik A, Szczudlik A (2004) Urine albumin excretion in acute ischaemic stroke is related to serum interleukin-6. Clin Chem Lab Med 42:182–185 CrossRef
- Fassbender K, Hodapp B, Rossol S, Bertsch T, Schmeck J, Schutt S, Fritzinger M, Horn P, Vajkoczy P, Kreisel S, Brunner J, Schmiedek P, Hennerici M (2001) Inflammatory cytokines in subarachnoid haemorrhage: association with abnormal blood flow velocities in basal cerebral arteries. J Neurol Neurosurg Psychiatry 70:534–537 CrossRef
- Hoogenberg K, Sluiter WJ, Navis G, Van Haeften TW, Smit AJ, Reitsma WD, Dullaart RPF (1998) Exogenous norepinephrine induces an enhanced microproteinuric response in microalbuminuric insulin-dependent diabetes mellitus. J Am Soc Nephrol 9:643–654
- Macmillan CSA, Grant IS, Andrews PJD (2002) Pulmonary and cardiac sequelae of subarachnoid haemorrhage: time for active management? Intensive Care Med 28:1012–1023 CrossRef
- Microalbuminuria is a prognostic predictor in aneurysmal subarachnoid hemorrhage
Intensive Care Medicine
Volume 33, Issue 6 , pp 1000-1006
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Urinary albumin creatinine ratio
- Subarachnoid hemorrhage
- Systemic inflammatory response
- Neurological outcome
- Glasgow Coma Scale
- Industry Sectors
- Author Affiliations
- 1. Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, 857-0134, Sasebo, Japan
- 2. Division of Anesthesiology, Department of Translational Medical Sciences, Nagasaki University School of Medicine, 1-7-1 Sakamoto, 852-8501, Nagasaki, Japan