N-terminal pro-brain natriuretic peptide’s serum level in severe traumatic brain injury

ABSTRACT

Introduction. During the last decade, multiple studies tried to assess the correlation between brain hemorrhage and increased levels of Brain Natriuretic Peptide. These studies highlight the association between BNP plasma concentrations after traumatic brain injury and elevated intracranial pressure.

Case presentation. We present a case of a 40-year-old male, victim of a car accident, found in prehospital with 5 pts Glasgow Coma Scale (GCS) and with severe head, thorax and lower right limb traumatic lesions. After the first evaluation, it was necessary to protect the airways and to intubate the patient. The computed tomography (CT) scan revealed multiple bone fractures of the skull with bilateral parietal epidural hematoma (30 mm thickness), pneumoencephaly, subarachnoid hemorrhage, concussion, multiple rib fractures with pulmonary contusion, double fractures of right fibula. Because the patient had severe thoracic and head trauma, we decided to complete the blood tests with N-terminal pro B-type Natriuretic Peptide (NT-proBNP) (736 pg/mL) and creatine kinase (CK) (3853 U/L).

Conclusions. The association of polytrauma with increased levels of NT-proBNP present a continuous interest for researchers. An exact correlation between cerebral/cardiac trauma and this natriuretic peptide precursor has not been fully demonstrated yet, especially regarding  the biological active form due to trauma. Further studies are currently performed to clarify the physiological role of this peptide, to confirm the correlation between its high levels and trauma, and to identify a specific role in the outcome of  severe traumatic patients.

Keywords: brain natriuretic peptide, polytrauma, severe traumatic brain injury, emergency medicine, chest trauma.

Corresponding author:
Cristina TASE GHINGULEAC
County Clinical Emergency Hospital of Constanta, Romania
Address: 542 Mamaia Ave, Bl. 2, Ap. 3, Constanta, Romania
E-mail: drcristinaghinguleac@gmail.com; Phone: +40799990221