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Could cardiac biomarkers predict neurogenic pulmonary edema in aneurysmal subarachnoid hemorrhage?

  • Original Article - Vascular
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Abstract

Background

Neurogenic pulmonary edema (NPE) is a clinical syndrome characterized by the acute onset of pulmonary edema after a significant central nervous system (CNS) insult. NPE occurs as a result of release of catecholamines into the blood immediately after aneurysm rupture. The aim of this study is to investigate the connection between the value of cardiac biomarkers on admission and incidence of NPE in patients with aneurysmal subarachnoid hemorrhage (SAH).

Methods

A total of 262 SAH patients (162 women, 100 men) were prospectively included in the study. Clinical characteristics, electrocardiographic (ECG) changes, serum cardiac and inflammatory biomarkers were measured on admission and on the day of development of NPE. These data were analyzed in order to predict the development NPE.

Results

Nineteen patients (7.25%) developed NPE. Comparison revealed that patients who subsequently developed NPE, sustained more severe SAH. Cardiac damage was more severe in these patients, as represented by significantly higher mean values of all examined cardiac biomarkers (P = 0.000), except for troponin I value that was significantly lower (P = 0.000). Multivariate regression analysis revealed that elevated troponin I (OR, 4.980; 95% CI, 1.27-19.49; P = 0.021) and white blood cell count (OR, 22.195; 95% CI, 3.99-123.50; P = 0.000) are predictors of NPE.

Conclusions

Significantly higher values of cardiac biomarkers were observed in SAH patients complicated with NPE. Elevated values of cardiac biomarkers appear to play an active role in prediction of NPE, although white blood cell count may be involved in the prediction of NPE. There is an influence of SAH therapy on predictors of NPE.

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Authors and Affiliations

  1. Department of Anesthesiology and Resuscitation on Clinic for Neurosurgery, Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Pasterova 2, Belgrade, Serbia

    Tijana Nastasovic, Branko Milakovic & Mila Stosic

  2. School of Medicine, University of Belgrade, Belgrade, Serbia

    Branko Milakovic, Jelena Eric Marinkovic & Danica Grujicic

  3. Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia

    Danica Grujicic

Authors
  1. Tijana Nastasovic
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  2. Branko Milakovic
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  3. Jelena Eric Marinkovic
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  4. Danica Grujicic
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  5. Mila Stosic
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Correspondence to Tijana Nastasovic.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.

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Comments

Nastasovic and co-workers analyze if cardiac biomarkers could predict neurogenic pulmonary edema (NPE) in aneurysmal subarachnoid hemorrhage (SAH). They prospectively included 262 SAH patients and found 19 patients with NPE.

In my opinion, this is an interesting study about an important problem in neurosurgical intensive care. The weaknesses of the study have been seen and adequately discussed by the authors. For me, the most important limitations are that no ultrasound examination of heart function was available and that the influence of SAH therapy, especially triple-H therapy, on the results described remains unclear. These points should be addressed in future studies about this topic.

Marcus Reinges

Giessen, Germany

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Nastasovic, T., Milakovic, B., Marinkovic, J.E. et al. Could cardiac biomarkers predict neurogenic pulmonary edema in aneurysmal subarachnoid hemorrhage?. Acta Neurochir 159, 705–712 (2017). https://doi.org/10.1007/s00701-017-3091-6

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  • DOI: https://doi.org/10.1007/s00701-017-3091-6

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