Neurocritical Care

, Volume 15, Issue 1, pp 13–18 | Cite as

Elevated BNP is Associated with Vasospasm-Independent Cerebral Infarction Following Aneurysmal Subarachnoid Hemorrhage

  • Pam R. Taub
  • Jeremy D. Fields
  • Alan H. B. Wu
  • Jacob C. Miss
  • Michael T. Lawton
  • Wade S. Smith
  • William L. Young
  • Jonathan G. Zaroff
  • Nerissa U. Ko
Original Article

Abstract

Background

Elevated levels of B-type natriuretic peptide (BNP) have been associated with cardiac dysfunction and adverse neurological outcomes after subarachnoid hemorrhage (SAH). We sought to determine whether elevated levels of BNP are independently associated with radiographic cerebral infarction after SAH.

Methods

Plasma BNP levels were measured after admission, a mean of 5.5 ± 3.0 days after SAH onset. Cerebral infarction was determined by retrospective review of computerized tomography (CT) scans. Cerebral vasospasm was confirmed by the presence of vascular narrowing on cerebral angiogram. The association between BNP and cerebral infarction was quantified using multivariable logistic regression and reverse stepwise elimination of clinical covariates. A stratified analysis was performed to quantify the association between BNP levels and infarction in patients with and without angiographic vasospasm.

Results

BNP levels were measured from 119 subjects. The median BNP level was 105 pg/ml (interquartile range 37–275 pg/ml). In our multivariable model, the top quartile of BNP levels (≥276 pg/ml) were associated with an increased odds of cerebral infarction (OR 4.2, P = 0.009). The stratified analysis showed that the association between BNP and infarction was strongest in patients without angiographic vasospasm (OR 7.8, P = 0.006).

Conclusions

Elevated levels of BNP are strongly and independently associated with cerebral infarction, and the association is most pronounced in patients without angiographic vasospasm. These results provide further evidence that other mechanisms can contribute to infarction, and BNP may be a useful biomarker in detecting patients at risk for adverse outcomes without large vessel vasospasm.

Keywords

Subarachnoid hemorrhage Cerebral infarction Cerebral vasospasm B-type natriuretic peptide 

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Pam R. Taub
    • 1
  • Jeremy D. Fields
    • 2
  • Alan H. B. Wu
    • 3
  • Jacob C. Miss
    • 4
  • Michael T. Lawton
    • 5
  • Wade S. Smith
    • 6
  • William L. Young
    • 5
    • 6
    • 7
  • Jonathan G. Zaroff
    • 8
  • Nerissa U. Ko
    • 6
  1. 1.Department of Medicine, Cardiology DivisionUniversity of CaliforniaSan DiegoUSA
  2. 2.Departments of Neurology and Interventional NeuroradiologyOregon Health & Science UniversityPortlandUSA
  3. 3.Department of Laboratory MedicineUniversity of CaliforniaSan FranciscoUSA
  4. 4.Department of Emergency MedicineUniversity of CaliforniaSan FranciscoUSA
  5. 5.Department of Neurological SurgeryUniversity of CaliforniaSan FranciscoUSA
  6. 6.Department of NeurologyUniversity of CaliforniaSan FranciscoUSA
  7. 7.Department of Anesthesia & Perioperative CareUniversity of CaliforniaSan FranciscoUSA
  8. 8.Kaiser Division of ResearchKaiser Permanente Medical CenterSan FranciscoUSA

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