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      The Prognostic Value of Midregional Proatrial Natriuretic Peptide in Patients with Hemorrhagic Stroke

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          Background: Atrial natriuretic peptide (ANP) is a well-known prognostic marker of outcome and mortality in patients with cardiovascular disease. Midregional proatrial natriuretic peptide (MR-proANP) is a stable fragment of the ANP precursor hormone. As a prognostic marker after ischemic stroke, it reliably predicts poststroke mortality and functional outcome. This study aimed to analyze the prognostic value of MR-proANP in patients with hemorrhagic stroke, i.e. subarachnoid (SAH) and intracerebral hemorrhage (ICH). Methods: MR-proANP was analyzed in patients with spontaneous SAH or spontaneous ICH. All patients were prospectively randomized into two treatment arms: (1) a prophylactic normothermia group with a target core temperature 36.5°C using endovascular cooling, and (2) a control group with conventional stepwise predefined fever management using antipyretic medication and surface cooling. Blood samples were obtained on admission and on days 4 and 7. Measurement of MR-proANP was performed in serum using sandwich immunoassay. The primary endpoint was functional outcome [assessed by the Glasgow Outcome Score (GOS)] and the secondary endpoints were mortality within 180 days after hemorrhagic stroke and influence of temperature on MR-proANP. A favorable outcome was defined as GOS 4-5, and the patients were considered to have a poor outcome with a 180-day GOS score between 1 and 3. Results: Analysis of MR-proANP was performed in 24 patients with spontaneous SAH and 22 patients with spontaneous ICH. MR-proANP was elevated on days 4 and 7 as compared to baseline levels (p < 0.05 and p < 0.001, respectively). High MR-proANP levels (>120 pmol/l) were associated with increased mortality and poor outcome (after 180 days; p < 0.05, respectively). There was no significant difference regarding MR-proANP serum concentrations between the endovascular and the control groups. Conclusions: Increased levels of MR-proANP are independently associated with poor functional outcome and increased mortality after 180 days in patients with hemorrhagic stroke. Endovascular temperature control had no significant influence on MR-proANP levels.

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          Most cited references 24

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          Natriuretic peptides.

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            Spontaneous intracerebral hemorrhage.

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              Aneurysmal subarachnoid hemorrhage.


                Author and article information

                Cerebrovasc Dis
                Cerebrovascular Diseases
                S. Karger AG
                February 2014
                30 January 2014
                : 37
                : 2
                : 128-133
                aDepartment of Neurology, Innsbruck Medical University, Innsbruck, Austria; bDepartment of Neurology, Universitätsspital Zürich, Zürich, and cMedical University Department of the University of Basel, Kantonsspital Aarau, Aarau, Switzerland; dInstitut für Experimentelle Endokrinologie und Endokrinologisches Forschungszentrum, EnForCé, Charité, Campus Virchow, Berlin, and eClinical Diagnostics, Thermo Scientific Biomarkers, Thermo Fisher Scientific, Hennigsdorf, Germany
                Author notes
                *Gregor Broessner, MD, Assistant Professor of Neurology, Innsbruck Medical University, Department of Neurology, Neurologic Intensive Care Unit, Anichstrasse 35, AT-6020 Innsbruck (Austria), E-Mail gregor.broessner@i-med.ac.at
                357215 Cerebrovasc Dis 2014;37:128-133
                © 2014 S. Karger AG, Basel

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                Page count
                Figures: 3, Tables: 1, Pages: 6
                Original Paper


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