Microalbuminuria is a prognostic predictor in aneurysmal subarachnoid hemorrhage

• Published in: Intensive care medicine 2007-06, Vol.33 (6), p.1000-1006
• Main Authors: TERAO, Yoshiaki, TAKADA, Masafumi, TANABE, Takahiro, ANDO, Yuko, FUKUSAKI, Makoto, SUMIKAWA, Koji
• Format: Article
• Language: English
• Subjects: Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Aged; Albuminuria; Albuminuria - urine; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aneurysms; Biological and medical sciences; Biomarkers; Blood pressure; Complications and side effects; Creatinine; Endocrinopathies; Female; Glasgow Coma Scale; Hemorrhage; Humans; Hypertension; Intensive care; Intensive care medicine; Intensive Care Units; Male; Medical imaging; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Patients; Permeability; Prognosis; Risk factors; Stroke; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - blood; Systemic Inflammatory Response Syndrome - blood; Thyroid. Thyroid axis (diseases); Urine; Vascular surgery
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-007-0617-z

To determine the prevalence and the prognostic significance of microalbuminuria in patients after aneurysmal subarachnoid hemorrhage (SAH). Prospective and observational clinical study. Multidisciplinary intensive care unit. Fifty-one consecutive patients who underwent aneurysm clipping or endovascular surgery after SAH; 8 patients who underwent surgical clipping for unruptured intracerebral aneurysm served as control. None. General clinical and neurological data were recorded on admission. Urine was collected preoperatively and daily for up to 7 days postoperatively for measuring the urinary microalbumin/creatinine ratio. The Glasgow Coma Scale (GCS) score was also determined on admission and daily for up to 7 days after operation. Neurological outcome was assessed using the Glasgow Outcome Scale (GOS) at 3 months after stroke. The prevalence rates of microalbuminuria were 74.5% in SAH and 37.5% in the control. Among the 51 patients, 25 had unfavorable neurological outcome (GOS 1-3). The areas under the receiver operator characteristic curves showed that the highest urinary microalbumin/creatinine ratio and the lowest GCS score during the first 8 days were the significant predictors of unfavorable neurological outcome. The threshold value, sensitivity, specificity, and likelihood ratio for the highest urinary microalbumin/creatinine ratio were 200 mg/g, 60% [95% confidence interval (CI) 41-79], 96% (95% CI 88-100), and 15.6 (95% CI 9.1-26.7), respectively. This study confirms a high prevalence of microalbuminuria in the SAH patients, and it suggests that the highest urinary microalbumin/creatinine ratio > 200 mg/g during the first 8 days is a significant predictor of unfavorable neurological outcome.