The Prognostic Value of Combined NT-pro-BNP Levels and NIHSS Scores in Patients with Acute Ischemic Stroke

Abstract

Objective Determining the prognoses of patients with acute ischemic stroke is difficult. Therefore, the aim of this study was to evaluate whether the combined assessment of plasma N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and the National Institutes of Health Stroke Scale (NIHSS) variables is relevant to the prognosis of patients with acute cerebral ischemic infarction in-hospital. Methods We enrolled 122 patients who were within three days of onset of acute ischemic stroke. We measured the plasma NT-pro-BNP level of each patient within 72 hours and recorded the NIHSS score on admission. The factors associated with death were investigated using a multivariate logistic regression analysis. Results Twenty-three patients (18.85%) died during hospitalization. The frequency of atrial fibrillation (AF), the NIHSS score on admission (8.69±4.87 in the survival group vs. 14.48±2.54 in the deceased group, p<0.001) and the plasma NT-pro-BNP level (median: 926.30 pg/mL in the survival group vs. 3,280 pg/mL in the deceased group, p<0.001; Lg NT-pro-BNP 2.82±0.66 in the survival group vs. 3.46±0.52 in the deceased group, p<0.001) were each significantly higher in the deceased group than in the survival group. The optimal cut-off levels for the NT-pro-BNP level and NIHSS score to distinguish the deceased group from the survival group were 1,583.50 pg/mL and 12.5, respectively. Patients with both elevated NT-pro-BNP levels (>1,583.50 pg/mL) and NIHSS scores on admission (NIHSS >12.5) had a substantially higher mortality rate than those without elevated NT-pro-BNP levels and NIHSS scores (89.47% vs. 9.84%, p<0.001). A multivariate logistic regression analysis demonstrated that a NT-pro-BNP level >1,583.50 pg/mL (OR, 5.001; 95% CI, 1.233 to 20.287, p=0.024) and a NIHSS score >12.5 (OR, 1.465; 95% CI, 1.191 to 1.801, p<0.001) were each independent factors associated with in-hospital death. Conclusion The plasma NT-pro-BNP level and the NIHSS score added independent and incremental contributions to the prognostic stratification of patients with acute ischemic stroke.

Soluble ST2 predicts outcome and hemorrhagic transformation after acute stroke

“…Together with other cardiac biomarkers such as troponin25 and B‐type natriuretic peptide (BNP),26, 27 our data highlight overlapping injury responses that occur following both cerebrovascular and cardiovascular injury. There are several possible interpretations of our findings in this context.…”

Role of N-Terminal Pro-B-Type Natriuretic Peptide, High-Sensitivity C-Reactive Protein, and Inteleukin-6 in Predicting a Poor Outcome after a Stroke

“…Emboli originating from heart atria can cause occlusion of major cerebral arteries, resulting in extensive cerebral infarction that is accompanied by severe neurological impairment. Indeed, it has been shown that greater BNP values correlate with a greater ischemic infarction volume on head CT [7]. On the other hand, hemorrhagic stroke is often due to rupture of the small perforating arteries that are damaged by long-standing arterial hypertension.…”

“…Increasing evidence also suggests that NT-proBNP is released in response to brain damage and thus can be a valuable biomarker in cerebrovascular disease. For example, it has been shown that in acute stroke patients greater NT-proBNP serum concentrations are associated with greater clinical stroke severity, greater short-term and long-term mortality rates, and worse functional outcomes [4,5,6,7,8]. NT-proBNP has been shown to predict stroke-related mortality better than indexes of clinical stroke severity [4,7].…”

“…For example, it has been shown that in acute stroke patients greater NT-proBNP serum concentrations are associated with greater clinical stroke severity, greater short-term and long-term mortality rates, and worse functional outcomes [4,5,6,7,8]. NT-proBNP has been shown to predict stroke-related mortality better than indexes of clinical stroke severity [4,7]. However, other authors have failed to demonstrate an association of NT-proBNP concentrations with stroke severity [9] and outcomes [10].…”

Brain Natriuretic Peptide (Bnp): Biomarker for Risk Stratification and Functional Recovery Prediction in Ischemic Stroke

“…Other authors used same combination of plasma NT-proBNP and NIHSS score in assessing in-hospital deaths: patients with NT-proBNP levels > 1583 pg/ml and NIHSS>12,5 on admission had a higher mortality rate (12) In another study (13), BNP plasma levels were higher among patients who deteriorated , BNP level being an independent predictor of neurological worsening and death in the acute phase after stroke.…”