Blood-based biomarkers for the long-term prognosis after acute ischemic stroke – results of the Linz Stroke Unit (LISU) study

Abstract

Background The aim of our study was to evaluate the long-term prognostic value of blood-based biomarkers in comparison to the established National Institute of Health stroke scale (NIHSS) score in patients with acute ischemic stroke. Methods We measured plasma concentrations of IL-6, NT-proBNP, D-dimer, hs-cTnT, sST2, MR-proADM, MR-proANP, CT-proET-1, Copeptin, and Procalcitonin in 721 consecutive acute ischemic stroke patients within 24 h after admission to our stroke unit. Endpoint was all-cause mortality at 3 years. Results During follow-up, 199 patients died (28%). In univariate Cox proportional hazards regression analyses using a dichotomized approach according to median values, all blood-based biomarkers were associated with prognosis. However, in the multivariate analysis after adjustment for several clinical variables, only IL-6 >7 pg/mL (risk ratio, 3.00; 95% CI, 2.03–4.44; P<0.001), NT-proBNP >447 ng/L (risk ratio, 2.67; 95% CI, 1.81–3.92; P<0.001), NIHSS score >3 (risk ratio, 2.24; 95% CI, 1.63–3.07; P<0.001), Copeptin >13 pmol/L (risk ratio, 1.87; 95% CI, 1.34–2.61; P<0.001), and hs-cTnT >14 ng/L (risk ratio, 1.74; 95% CI, 1.21–2.49; P=0.001) remained independent predictors. ROC curve analysis for mortality prediction demonstrated a higher area under the curve (AUC) for IL-6 and NT-proBNP, respectively, when compared to the NIHSS score (IL-6 AUC 0.81 vs. NIHSS AUC 0.75; P=0.016 and NT-proBNP AUC 0.80 vs. NIHSS AUC 0.75; P=0.039) and similar AUCs when comparing the NIHSS with hs-TnT (hs-TnT AUC 0.77) and Copeptin (Copeptin AUC 0.72). Conclusions In this large cohort of patients with acute ischemic stroke the blood-based biomarkers IL-6, NT-proBNP, hs-cTnT, and Copeptin were strong and independent prognostic markers for 3-year all-cause mortality. IL-6 and NT-proBNP even outperformed the NIHSS score for long-term mortality prediction. ROC plots for 3-year all-cause mortality Funding Acknowledgement Type of funding source: None