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

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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.

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Acknowledgments

This study was supported by the National Institutes of Health (NHLBI K23 HL04054-01A1 and NINDS 1R21 NS050551-01, PI Zaroff; NINDS K23 NS044014 and K02 NS60892, PI Ko), the Charles A. Dana Foundation, and a gift from The Pritzker Cousins Foundation, John A. Pritzker, Director. These agencies had no direct role in the study design, data collection, analysis, interpretation, manuscript preparation, or the decision to submit the manuscript for publication.

Conflicts of interest

The authors have no conflicts of interest related to this study.

Author information

Authors and Affiliations

  1. Department of Medicine, Cardiology Division, University of California, San Diego, CA, USA

    Pam R. Taub

  2. Departments of Neurology and Interventional Neuroradiology, Oregon Health & Science University, Portland, OR, USA

    Jeremy D. Fields

  3. Department of Laboratory Medicine, University of California, San Francisco, CA, USA

    Alan H. B. Wu

  4. Department of Emergency Medicine, University of California, San Francisco, CA, USA

    Jacob C. Miss

  5. Department of Neurological Surgery, University of California, San Francisco, CA, USA

    Michael T. Lawton & William L. Young

  6. Department of Neurology, University of California, 505 Parnassus Avenue, M830, San Francisco, CA, 94114, USA

    Wade S. Smith, William L. Young & Nerissa U. Ko

  7. Department of Anesthesia & Perioperative Care, University of California, San Francisco, CA, USA

    William L. Young

  8. Kaiser Division of Research, Kaiser Permanente Medical Center, San Francisco, CA, USA

    Jonathan G. Zaroff

Authors
  1. Pam R. Taub
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  2. Jeremy D. Fields
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  3. Alan H. B. Wu
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  4. Jacob C. Miss
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  5. Michael T. Lawton
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  6. Wade S. Smith
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  7. William L. Young
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  8. Jonathan G. Zaroff
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  9. Nerissa U. Ko
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Corresponding author

Correspondence to Nerissa U. Ko.

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Taub, P.R., Fields, J.D., Wu, A.H.B. et al. Elevated BNP is Associated with Vasospasm-Independent Cerebral Infarction Following Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 15, 13–18 (2011). https://doi.org/10.1007/s12028-011-9535-6

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  • DOI: https://doi.org/10.1007/s12028-011-9535-6

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