Early NT-ProBNP (N-Terminal Probrain Natriuretic Peptide) Elevation Predicts Malignant Edema and Death After Reperfusion Therapy in Acute Ischemic Stroke Patients

Abstract

Background and Purpose: We aimed to investigate the relationship between early NT-proBNP (N-terminal probrain natriuretic peptide) and all-cause death in patients receiving reperfusion therapy, including intravenous thrombolysis and endovascular thrombectomy (EVT). Methods: This study included 1039 acute ischemic stroke patients with early NT-proBNP data at 2 hours after the beginning of alteplase infusion for those with intravenous thrombolysis only or immediately at the end of EVT for those with EVT. We performed natural log transformation for NT-proBNP (Ln(NT-proBNP)). Malignant brain edema was ascertained by using the SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study) criteria. Results: Median serum NT-proBNP level was 349 pg/mL (interquartile range, 89–1250 pg/mL). One hundred twenty-one (11.6%) patients died. Malignant edema was observed in 78 (7.5%) patients. Ln(NT-proBNP) was independently associated with 3-month mortality in patients with intravenous thrombolysis only (odds ratio, 1.465 [95% CI, 1.169–1.836]; P =0.001) and in those receiving EVT (odds ratio, 1.563 [95% CI, 1.139–2.145]; P =0.006). The elevation of Ln(NT-proBNP) was also independently associated with malignant edema in patients with intravenous thrombolysis only (odds ratio, 1.334 [95% CI, 1.020–1.745]; P =0.036), and in those with EVT (odds ratio, 1.455 [95% CI, 1.057–2.003]; P =0.022). Conclusions: An early increase in NT-proBNP levels was related to malignant edema and stroke mortality after reperfusion therapy.

Plasma Lipid Mediators Associate With Clinical Outcome After Successful Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

“…Moreover, blood-based biomarkers are also found to be predictive for unfavorable early (END) and long-term functional outcomes of EVT-treated AIS patients, including interleukin-6, NLR, N-terminal probrain natriuretic peptide, albumin, matrix metalloprotease-9, enascin-c, thioredoxin, ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13, and occludin, etc. ( 2 , 3 , 10 , 31 – 35 ). We have recently reported that high levels of the pro-resolving protein mediator annexin A1 correlated with 3-month clinical outcomes of AIS patients who underwent successful recanalization by EVT ( 36 ).…”

“…Recanalization is often accompanied by cerebral ischemia-reperfusion (I/R) injury, which has been shown as a major cause of early complications, long-term neurological dysfunctions, or even death of AIS patients undergoing EVT ( 2 , 3 ). Innate immunity and acute inflammatory response within the penumbra play important roles in the pathological progression of cerebral I/R injury.…”

N-Terminal Pro-brain Natriuretic Peptide Is Associated With Hemorrhagic Transformation and Poor Outcomes in Patients With Stroke Treated With Intravenous Thrombolysis

“…A meta-analysis reported an association between NT-proBNP levels and all-cause mortality (OR 2.43, 95% CI 1.62–3.64) and an association between NT-proBNP levels and cardiovascular mortality (OR 2.01, 95% CI, 1.55–2.61) ( Zhao et al, 2020 ). Considering the NT-proBNP levels in patients who underwent intravenous thrombolysis, one study reported that NT-proBNP levels were associated with 3-month mortality in patients with stroke who underwent intravenous thrombolysis (OR 1.334, 95% CI 1.020–1.745) ( Zhang X. et al, 2021 ). In the present study, NT-proBNP levels were independently associated with 3-month mortality, which is consistent with the findings of the previous study.…”

“…A meta-analysis of five studies found that NT-proBNP levels were associated with functional outcomes (OR 1.68, 95% CI 1.13–2.50) ( Otaki et al, 2019 ; Zhao et al, 2020 ). Considering the performance of NT-proBNP in patients who underwent intravenous thrombolysis, a previous study reported a tendency of poor functional outcomes as NT-proBNP levels increased ( Zhang X. et al, 2021 ). In our study, we found an independent association between NT-proBNP levels and poor 3-month functional outcomes in patients who underwent intravenous thrombolysis.…”

“…One study reported a higher modified Rankin scale (mRS) in patients with high BNP levels who underwent intravenous thrombolysis (Gupta et al, 2019). Similarly, another study reported that increased NT-proBNP levels were associated with malignant edema and mortality in patients who had undergone intravenous thrombolysis or endovascular treatment (Zhang X. et al, 2021). The prognostic validity of NT-proBNP levels in patients with stroke who underwent intravenous thrombolysis is not as well-understood.…”