Prognostic Value of Plasma Neuroendocrine Biomarkers in Patients with Acute Ischaemic Stroke

Abstract

Inflammation and activation of the neuroendocrine systems comprise important aspects of stroke pathophysiology. The present study investigated whether baseline plasma brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), cortisol and copeptin levels on admission can predict short-term outcomes and mortality after acute ischaemic stroke. The study group consisted of 189 patients who had their first acute ischaemic stroke. Plasma levels of BNP, NT-proBNP, cortisol and copeptin were evaluated to determine their value with respect to predicting functional outcome and mortality within 3 months. As a result of cardiovascular and neurological investigations (including imaging techniques), lesion size, stroke subtype classification and clinical outcome after 3 months were determined. Plasma levels of BNP, NT-proBNP, cortisol and copeptin were associated with stroke severity, as well as short-term functional outcomes. After adjusting for all other significant outcome predictors, NT-proBNP, cortisol and copeptin remained as independent outcome predictors. In the receiver operating characteristic curve analysis, the biomarker panel (including BNP, NT-proBNP, cortisol and copeptin) predicted functional outcome and death within 90 days significantly more efficiently than the National Institute of Health Stroke Scale (NIHSS) or the biomarker alone. Copeptin showed a significantly greater discriminatory ability as a single biomarker compared to BNP, NT-proBNP, cortisol and NIHSS score. These results suggest that a biomarker panel may add valuable and time-sensitive prognostic information in the early evaluation of acute ischaemic stroke. This may provide a channel for interventional therapy in acute stroke.

The Link between Early Biomarker Analysis and the Neurological Outcome in Stroke Patients

“…This study measured the outcome at three months [17]. Wang measured the mRS at one month post stroke, the other two significant studies also measured the outcome at three months [16,32,36]. A study by Matsumoto whose data could not be included found a link between low D-dimer concentrations and a good outcome at discharge.…”

“…Both studies were independently significant. Both measured the outcome at three months [21,32]. It can be assumed that low GPT concentrations at admission predict a bad neurological outcome at three months post stroke.…”

“…All three included studies measured the outcome at three months [32,44,45]. Low cortisol levels are possibly linked to a good outcome at three months.…”

Neuroimagem e Biomarcadores no Prognóstico Funcional de Doentes com Acidente Vascular Cerebral

“…30 Têm sido efetuados estudos na procura de potenciais marcadores do diagnóstico de AVC, estratificação de risco e previsão de prognóstico. 31 Ainda são poucos os biomarcadores que preenchem os requisitos necessários para serem introduzidos na prática clínica. 4 Embora alguns dos marcadores demonstrem capacidade preditiva, nenhum estudo foi suficiente para validar um modelo clínico baseado na utilização destes marcadores.…”

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

“…Some authors postulate that the biomarker panel (BNP, NT-proBNP, cortisol and copeptin) predicted functional outcome and death within 90 days more efficiently than the NIHSS score (16) BNP levels were found to be significantly higher in patients with larger infarcts and higher mRS scores (17). Higher BNP levels were independently associated with more proximal carotid axis occlusion, thus with larger infarct area (18) BNP levels in patients with an unfavorable outcome after 90 days and after 1 year were significantly higher than those in patients with a favorable outcome (14).…”