A pilot study of dendroaspis natriuretic peptide in aneurysmal subarachnoid hemorrhage.
OBJECTIVE
Hypovolemia after aneurysmal subarachnoid hemorrhage (SAH) may be mediated by natriuretic peptides and can further impair cerebral perfusion in dysautoregulated and vasospastic arterial territories. Dendroaspis natriuretic peptide (DNP), derived from the venom of Dendroaspis augusticeps, the Green Mamba snake, has recently been discovered in human plasma and atrial myocardium. There is no information regarding the presence or putative role of this peptide in patients with aneurysmal SAH.


METHODS
A sensitive and specific DNP radioimmunoassay was performed on venous blood samples obtained on post-SAH Days 1, 3, and 7 from 10 consecutive SAH patients (cases) and randomly from 9 healthy volunteers (controls). Clinical and laboratory data, including daily serum sodium concentration and fluid balance, were collected prospectively up to 7 days after the ictus.


RESULTS
Increase in plasma DNP levels occurred in five (63%) of eight patients who had DNP levels measured on Days 1 and 3 (mean increase, 29%). An increase in DNP level was significantly associated with development of a negative fluid balance (P = 0.003) and hyponatremia (P = 0.008). Three (75%) of the four patients who developed cerebral vasospasm during this study experienced an increase in DNP levels from Days 1 to 3.


CONCLUSIONS
The present study is the first to find a significant association between elevated levels of DNP, a new member of the natriuretic peptide family, and the development of diuresis and natriuresis in patients with aneurysmal SAH. Our findings warrant further investigation by means of a large-scale, prospective, case-control study.
Khurana
Vini G
VG
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Wijdicks
Eelco F M
EF
Heublein
Denise M
DM
McClelland
Robyn L
RL
Meyer
Fredric B
FB
Piepgras
David G
DG
Burnett
John C
JC
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004231:Diuresis / Q000502:physiology; D004546:Elapid Venoms / Q000097:blood*; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000209:etiology; D036341:Intercellular Signaling Peptides and Proteins; D008297:Male; D008875:Middle Aged; D045265:Natriuretic Peptides / Q000097:blood*; D010455:Peptides / Q000097:blood*; D010865:Pilot Projects; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000150:complications; D013997:Time Factors; D020301:Vasospasm, Intracranial / Q000097:blood / Q000209:etiology
C075597:Dendroaspis natriuretic peptide; D004546:Elapid Venoms; D036341:Intercellular Signaling Peptides and Proteins; D045265:Natriuretic Peptides; D010455:Peptides