Characteristics and prognostic value of acute catecholamine surge in patients with aneurysmal subarachnoid hemorrhage.
OBJECTIVE
The characteristics of serum catecholamine concentration at the hyper-acute phase of aneurysmal subarachnoid hemorrhage (SAH) and its relationship between patient outcome and delayed vasospasm were investigated.


METHODS
Patients with aneurysmal SAH (170) were prospectively studied between August 2008 and June 2011. Baseline demographic data and physiological parameters, including plasma concentrations of adrenaline (AD), noradrenaline (NA), and dopamine (DP) were evaluated for all patients.


RESULTS
On admission, plasma AD, NA, and DP levels were significantly higher in patients with a poor clinical grade on admission (Hunt and Kosnik grade: IV-V), compared to those with a good clinical grade on admission (Hunt and Kosnik grade: I-III). AD showed a markedly high concentration immediately after the onset of SAH and then rapidly decreased. NA levels peaked within 6 hours after onset, then significantly decreased. The increase of DP with time was not significant, but showed a similar trend to that of NA. The level of each catecholamine showed significant mutual correlation. Our multivariate model demonstrated that age, poor clinical grade at admission, plasma AD and NA levels were good predictors of poor patient outcome [receiver operating characteristic (ROC) area: 0.83]. And that poor clinical grade at admission, Fisher scale, blood sugar level and plasma AD level were good predictors of the development of delayed vasospasm (ROC area: 0.81) (1.3).


CONCLUSIONS
The present findings suggest that sympathetic activation in patients in the acute phase of SAH reflects the severity of SAH, and is closely related to the development of delayed vasospasm, leading to the subsequent immune response and inflammatory reactions. Strategies for suppressing catecholamine at the hyper-acute phase may contribute to vasospasm prevention and improve patient outcome.
International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan. takeshi_@saitama-med.ac.jp
Takeshi
T
Ogura
Akira
A
Satoh
Hidetoshi
H
Ooigawa
Tatsuya
T
Sugiyama
Ririko
R
Takeda
Goji
G
Fushihara
Shin-Ichiro
S
Yoshikawa
Daisuke
D
Okada
Hiromichi
H
Suzuki
Ryuichiro
R
Araki
Shoichiro
S
Ishihara
Ryo
R
Nishikawa
Hiroki
H
Kurita
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002395:Catecholamines / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000150:complications* / Q000175:diagnosis*; D013997:Time Factors; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000209:etiology*
D002395:Catecholamines