Neurogenic Myocardial and Lung Injury in SAH Patients
Study Details
Study Description
Brief Summary
Up to this day, little is known whether the extent of brain damage in patients with SAH correlates with the degree neurogenic myocardial injury and neurogenic lung injury.
This is a prospective observational study designed to asses relationship between catecholamine surge and development of myocardial and lung injury in subarachnoid haemorrhage patients.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Multiple forms of brain damage, primarily, subarachnoid haemorrhage (SAH) are frequently accompanied by neurogenic myocardial injury with changes in the electrocardiogram, accompanied by the release of markers of myocardial injury. This form of cardiac dysfunction is thought to be mediated by cellular toxicity associated with catecholamine release. Central nervous system damage in the course of intracranial haemorrhage may, in a similar pathogenic pathway, lead to neurogenic lung injury. Up to this day, little is known whether the extent of brain damage in patients with SAH correlates with the degree of neurogenic myocardial injury. Moreover, it remains unknown what is the full clinical picture and duration of this type of myocardial injury and how often it co-occurs with neurogenic lung injury. Such analysis is a fundamental and most important step in optimising the treatment of these patients.
Methods: In this prospective observational study the authors aim to recruit 30 patients with subarachnoid haemorrhage, requiring hospitalization in the Intensive Care Unit. The patients will be monitored for elevation in cardiac damage markers (hs-TnT, CPK, CK-MB, NT-proBNP) and worsening of respiratory conditions, defined by need for more invasive ventilation parameters, and subsequent changes in arterial blood gas. The above mentioned parameters will be assessed every 12 hours. Additionally, the patients will be screened for an elevation in catecholamine metabolite (metanephrine) concentration in 12-hour urine collection.
Hypothesis to be tested: Myocardial and lung injury in SAH patients is timely-associated with an increase in metanephrine concentration in urine.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Patients with subarachnoid haemorrhage Patients aged 18 or older hospitalized in the Intensive Care Unit with Subarachnoid Haemorrhage. |
Diagnostic Test: hs-TnT (high-sensitive cardiac troponin T) plasma concentration
hs-TnT plasma concentration measured once every 12 hours
Diagnostic Test: CK-MB (creatine kinase myocardial band) plasma concentration
CK-MB plasma concentration measured every 12 hours
Diagnostic Test: CPK (creatine phosphokinase) plasma concentration
CPK plasma concentration measured every 12 hours
Diagnostic Test: NT-proBNP (N-terminal prohormone of brain natriuretic peptide) plasma concentration
NT-proBNP plasma concentration measured every 12 hours
Diagnostic Test: Metanephrine concentration in urine
Metanephrine concentration measured in 12-hour urine collection using spectrophotometry.
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Outcome Measures
Primary Outcome Measures
- In-hospital death (number of patients) [7 days]
Death of the patient during the first 7 days of hospitalization.
- Number of Patients with elevation in hs-TnT levels [7 days]
hs-TnT treated as myocardial injury biomarker
- Number of Patients with elevation in NT-proBNP levels [7 days]
NT-proBNP treated as myocardial injury biomarker
- Number of Patients with elevation in creatine kinase levels [7 days]
Creatine kinase treated as myocardial injury biomarker
- Number of Patients with elevation in creatine kinase MB levels [7 days]
Creatine kinase MB treated as myocardial injury biomarker
- Number of Patients with a decrease in Horowitz index [7 days]
The decrease in Horowitz index treated as a sign of need for more invasive ventilation parameters with subsequent blood gas changes
- Number of Patients with need of increased FiO2 [7 days]
Need of increased FiO2 treated as a sign of need for more invasive ventilation parameters with subsequent blood gas changes
- Number of Patients with need of increased PEEP values [7 days]
Need of increased PEEP values treated as a sign of need for more invasive ventilation parameters with subsequent blood gas changes
- Number of Patients with need for the use of neuro-muscular blocking agents [7 days]
Need for the use of neuro-muscular blocking agents treated as a sign of need for more invasive ventilation parameters with subsequent blood gas changes
Eligibility Criteria
Criteria
Inclusion Criteria:
- patients with subarachnoid haemorrhage (both aneurysmal and non-aneurysmal) with acute consciousness disturbances (Glasgow Coma Scale < 8 pts) requiring intubation and mechanical ventilation, hospitalized in the ICU for over 24 hours
Exclusion Criteria:
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severe prior pulmonary diseases
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severe prior cardiac diseases
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death in the first 72 hours of ICU stay
-
need for any extracorporeal life-saving techniques
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University Clinical Center prof. K. Gibiński of the Medical University of Silesia in Katowice | Katowice | Województwo Śląskie | Poland | 40-752 |
Sponsors and Collaborators
- Medical University of Silesia
Investigators
- Study Chair: Łukasz Krzych, PhD, University Clinical Center prof. K. Gibiński of the Medical University of Silesia in Katowice
Study Documents (Full-Text)
None provided.More Information
Publications
- Anetsberger A, Jungwirth B, Blobner M, Ringel F, Bernlochner I, Heim M, Bogdanski R, Wostrack M, Schneider G, Meyer B, Graeßner M, Baumgart L, Gempt J. Association of Troponin T levels and functional outcome 3 months after subarachnoid hemorrhage. Sci Rep. 2021 Aug 9;11(1):16154. doi: 10.1038/s41598-021-95717-w.
- Hofman M, Hajder N, Duda I, Krzych ŁJ. A Questionnaire Survey of Management of Patients with Aneurysmal Subarachnoid Haemorrhage in Poland. Int J Environ Res Public Health. 2020 Jun 11;17(11). pii: E4161. doi: 10.3390/ijerph17114161.
- Mazeraud A, Robba C, Rebora P, Iaquaniello C, Vargiolu A, Rass V, Bogossian EG, Helbok R, Taccone FS, Citerio G. Acute Distress Respiratory Syndrome After Subarachnoid Hemorrhage: Incidence and Impact on the Outcome in a Large Multicenter, Retrospective Cohort. Neurocrit Care. 2021 Jun;34(3):1000-1008. doi: 10.1007/s12028-020-01115-x. Epub 2020 Oct 20.
- Osgood ML. Aneurysmal Subarachnoid Hemorrhage: Review of the Pathophysiology and Management Strategies. Curr Neurol Neurosci Rep. 2021 Jul 26;21(9):50. doi: 10.1007/s11910-021-01136-9. Review.
- Veeravagu A, Chen YR, Ludwig C, Rincon F, Maltenfort M, Jallo J, Choudhri O, Steinberg GK, Ratliff JK. Acute lung injury in patients with subarachnoid hemorrhage: a nationwide inpatient sample study. World Neurosurg. 2014 Jul-Aug;82(1-2):e235-41. doi: 10.1016/j.wneu.2014.02.030. Epub 2014 Feb 20.
- Wybraniec M, Mizia-Stec K, Krzych L. Stress cardiomyopathy: yet another type of neurocardiogenic injury: 'stress cardiomyopathy'. Cardiovasc Pathol. 2014 May-Jun;23(3):113-20. doi: 10.1016/j.carpath.2013.12.003. Epub 2013 Dec 27. Review.
- Wybraniec MT, Mizia-Stec K, Krzych Ł. Neurocardiogenic injury in subarachnoid hemorrhage: A wide spectrum of catecholamin-mediated brain-heart interactions. Cardiol J. 2014;21(3):220-8. doi: 10.5603/CJ.a2014.0019. Epub 2014 Feb 14. Review.
- PCN/0022/KB/206/20