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The role of catecholamines in the pathogenesis of neurogenic pulmonary edema associated with subarachnoid hemorrhage.

Authors :
Inamasu J
Sugimoto K
Yamada Y
Ganaha T
Ito K
Watabe T
Hayashi T
Kato Y
Ozaki Y
Hirose Y
Source :
Acta neurochirurgica [Acta Neurochir (Wien)] 2012 Dec; Vol. 154 (12), pp. 2179-84; discussion 2184-5. Date of Electronic Publication: 2012 Oct 09.
Publication Year :
2012

Abstract

Background: Neurogenic pulmonary edema (NPE) occurs frequently after aneurysmal subarachnoid hemorrhage (SAH), and excessive release of catecholamines (epinephrine/norepinephrine) has been suggested as its principal cause. The objective of this retrospective study is to evaluate the relative contribution of each catecholamine in the pathogenesis of NPE associated with SAH.<br />Methods: Records of 63 SAH patients (20 men/43 women) whose plasma catecholamine levels were measured within 48 h of SAH onset were reviewed, and the clinical characteristics and laboratory data of those who developed early-onset NPE were analyzed thoroughly.<br />Results: Seven patients (11 %) were diagnosed with NPE on admission. Demographic comparison revealed that the NPE+ group sustained more severe SAH than the NPE- group. Cardiac dysfunction was also significantly more profound in the former, and the great majority of the NPE+ group sustained concomitant cardiac wall motion abnormality. There was no significant difference in the plasma epinephrine levels between NPE+ and NPE- group (324.6 ± 172.8 vs 163.1 ± 257.2 pg/ml, p = 0.11). By contrast, plasma norepinephrine levels were significantly higher in the NPE+ group (2977.6 ± 2034.5 vs 847.9 ± 535.6 pg/ml, p < 0.001). Multivariate regression analysis revealed that increased norepinephrine levels were associated with NPE (OR, 1.003; 95 % CI, 1.002-1.007). Plasma epinephrine and norepinephrine levels were positively correlated (R = 0.48, p < 0.001). According to receiver operating characteristic curve analysis, the threshold value for plasma norepinephrine predictive of NPE was 2,000 pg/ml, with an area under the curve value of 0.85.<br />Conclusions: Elevated plasma norepinephrine may have more active role in the pathogenesis of SAH-induced NPE compared with epinephrine, although both catecholamines may be involved via multiple signaling pathways.

Details

Language :
English
ISSN :
0942-0940
Volume :
154
Issue :
12
Database :
MEDLINE
Journal :
Acta neurochirurgica
Publication Type :
Academic Journal
Accession number :
23053288
Full Text :
https://doi.org/10.1007/s00701-012-1515-x