How to predict neurogenic pulmonary edema in aneurysmal subarachnoid hemorrhage?: Neurogenic pulmonary edema in aneurysmal SAH

Abstract

Introduction: Neurogenic pulmonary edema (NPE) is a clinical syndrome characterized by the acute onset of pulmonary edema after sudden raise of intracranial pressure. NPE is the result of release of catecholamines into the circulation immediately after intracranial hemorrhage. The aim of this study is to investigate a possible correlation between the values of cardiac biomarkers on admission and incidence of NPE in patients with aneurysmal subarachnoid hemorrhage (SAH). Methods: Prospective study includes 262 patients with SAH (162 females). Clinical characteristics, serum cardiac and inflammatory biomarkers were measured on admission and on the day of development of NPE. These data were analysed by tests of statistical significance and binary logistic regression analysis in order to predict the development of NPE. Results: 19 patients (7.25%) developed NPE. Statistical analysis revealed that patients who subsequently developed NPE experienced more severe SAH. Cardiac damage was more severe in these patients, as represented by significantly higher number of patients with elevated values of all examined cardiac biomarkers (P from < 0.001 to 0.004). Multivariate regression analysis revealed that elevated troponin I (OR 4.980; 95% CI 1.27-19.49, P = 0.021) and white blood cells count (OR 22.195; 95% CI 3.99-123.50, P < 0.001) were predictors of NPE. Conclusion: Significantly higher number of patients with elevated values of cardiac biomarkers had SAH complicated with NPE. Elevated values of cardiac biomarkers might play an active role in prediction of NPE, although white blood cells count may be involved in the prediction of NPE.

Keywords

• subarachnoid haemorrhage
• neurogenic pulmonary edema
• cardiac biomarkers ecg changes