Procalcitonin and Midregional Proatrial Natriuretic Peptide as Markers of Ischemic Stroke

Abstract

Background and Purpose Chronic infections and neuroendocrine dysfunction may be risk factors for ischemic stroke. We hypothesized that selected blood biomarkers of infection (procalcitonin, or PCT), hypothalamic-pituitary-axis function (copeptin), and hemodynamic dysfunction (midregional-pro-atrial natriuretic peptide, or MRproANP) are associated with incident ischemic stroke risk in the multiethnic, urban Northern Manhattan Study (NOMAS) cohort. Methods A nested case-control study was performed among initially stroke-free participants. Cases were defined as first ischemic stroke (n=172). We randomly selected controls among those who did not develop an event (n=344). We calculated Cox proportional hazards models with inverse probability weighting to estimate the association of blood biomarkers with risk of stroke after adjusting for demographic, behavioral, and medical risk factors. Results Those with PCT and MRproANP, but not copeptin, in the top quartile, compared to the lowest quartile, were associated with ischemic stroke (for PCT adjusted HR 1.9, 95% CI 1.0–3.8; for MRproANP adjusted HR 3.5, 95% CI 1.6–7.5). The associations of PCT and MRproANP differed by stroke etiology; PCT-levels in the top quartile were particularly associated with small vessel stroke (adjusted HR 5.1, 95% CI 1.4–18.7) and MRproANP-levels with cardioembolic stroke (adjusted HR 16.3, 95% CI 3.7–70.9). Conclusion Higher levels of procalcitonin, a marker of infection, and MRproANP, a marker for hemodynamic stress, were independently associated with ischemic stroke risk. PCT was specifically associated with small vessel and MRproANP with cardioembolic stroke risk. Further study is needed to validate these biomarkers and determine their significance in stroke risk prediction and prevention.

Serum levels of procalcitonin and high sensitivity C-reactive protein are associated with long-term mortality in acute ischemic stroke

“…This finding supported the finding from a previous study and suggested that PCT also contributes to the inflammatory process in the clinical setting of AIS [18]. Systemic markers of inflammation have been shown to be risk markers of stroke.…”

“…Schiopu et al [17] demonstrated a positive association between plasma PCT levels and cardiovascular risk in subjects with no previous history of acute cardiovascular events, while Katan et al [18] reported that higher levels of PCT, a marker of infection, were independently associated with ischemic stroke risk in this multiethnic, urban cohort.…”

Procalcitonin and Midregional Proatrial Natriuretic Peptide as Biomarkers of Subclinical Cerebrovascular Damage

“…Serum procalcitonin (PCT) concentrations correlate with the extent and severity of microbial invasion 6 . In a recent study nested within in the Northern Manhattan Study (NOMAS), PCT concentrations were associated specifically with small vessel stroke 7 .…”

“…There is increasing evidence supporting the potential role of elevated natriuretic peptides as risk factors of cognitive impairment. 9 Midregional pro-atrial natriuretic peptide (MR-proANP) has been shown to be associated specifically with cardioembolic stroke etiology 7, 10 .…”

“…Thus we hypothesized that PCT, as a surrogate for bacterial infections, and MR-proANP, as a marker of cardiac dysfunction, previously associated with small vessel stroke and cardioembolic stroke 7 , respectively, would also be associated with MRI measures of SCVD in the ethnically diverse Northern Manhattan population.…”