Prognostic Value of Natriuretic Peptides for Delayed Cerebral Ischemia and Outcomes After Aneurysmal Subarachnoid Hemorrhage: An Updated-Systematic Review and Meta-Analysis.
Gustavo Adolfo Villegas-Gomez, Oscar Iván Molina, Alejandra Ramírez-Romero et al.
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In 30 seconds
This systematic review and meta-analysis examined observational studies of natriuretic peptide (NP) levels measured within 7 days of aneurysmal subarachnoid hemorrhage (aSAH) and their association with delayed cerebral ischemia (DCI), mortality, and functional outcomes. Seventeen studies involving 3172 patients were included; 12 contributed to quantitative synthesis. Elevated NP levels were associated with DCI in dichotomous analyses (OR 2.66, 95% CI 1.16-6.10) and adjusted analyses (aOR 1.84, 95% CI 1.01-3.35). Associations with mortality and unfavorable functional outcomes were not statistically significant.
Key findings
- Elevated NP levels were associated with DCI in dichotomous analyses (OR 2.66, 95% CI 1.16-6.10).
- The association with DCI persisted in adjusted models (aOR 1.84, 95% CI 1.01-3.35).
- Admission NP had moderate accuracy for predicting DCI (pooled AUC 0.76).
- No statistically significant associations were found for mortality (OR 2.37, 95% CI 0.66-8.50) or unfavorable functional outcomes (OR 1.90, 95% CI 0.65-5.52).
Why it matters
DCI is a serious secondary complication after aSAH, and early risk assessment remains an important clinical challenge. The pooled association and moderate predictive accuracy suggest NP levels may provide prognostic information about DCI. However, the findings do not establish that NP-guided decisions improve outcomes, and the evidence for mortality and functional prognosis remains inconclusive.
What to keep in mind
The evidence came from observational studies, heterogeneity across studies was substantial, and the authors call for larger prospective studies with standardized methods.