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

Chen, Xingyong; Xu, Zhan; Chen, Mingfeng; Lei, Huixing; Wang, Yingzhou; De, Wei; Jiang, Xiulong

doi:10.2169/internalmedicine.51.8027

Cited by 45 publications

(44 citation statements)

References 27 publications

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“…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.…”

Section: Discussionmentioning

confidence: 55%

Soluble ST2 predicts outcome and hemorrhagic transformation after acute stroke

Wolcott

Batra

Bevers

et al. 2017

Ann Clin Transl Neurol

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Objective ST2 is a member of the toll‐like receptor superfamily that can alter inflammatory signaling of helper T‐cells. We investigated whether soluble ST2 (sST2) could independently predict outcome and hemorrhagic transformation (HT) in the setting of stroke.MethodsWe measured sST2 in patients enrolled in the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) network biomarker study. 646 patients had plasma samples collected at the time of hospital admission and 210 patients had a second sample collected 48 h after stroke onset. Functional outcome was assessed using the modified Rankin Scale (mRS), with good and poor outcomes defined as mRS 0‐2 and 3‐6, respectively. HT was classified using ECASS criteria. The relationships between sST2, outcome, and HT were evaluated using multivariable logistic regression, Kaplan–Meier survival analysis and receiver operating characteristic curves.Results646 patients were included in the analysis (mean age 69 years; 44% women), with a median NIHSS of 5 [IQR: 2–12]. The median sST2 level on hospital admission was 35.0 ng/mL [IQR: 25.7–49.8 ng/mL] and at 48 h it was 37.4 ng/mL [IQR 27.9–55.6 ng/mL]. sST2 was independently associated with poor outcome (OR: 2.77, 95% CI: 1.54–5.06; P = 0.003) and mortality (OR: 3.56, 95% CI: 1.58–8.38, P = 0.001) after multivariable adjustment. Plasma sST2 was also associated with hemorrhagic transformation after adjustment for traditional risk factors (OR: 5.58, 95% CI: 1.40–37.44, P = 0.039).InterpretationSoluble ST2 may serve as a prognostic biomarker for outcome and hemorrhagic transformation in patients with acute stroke. ST2 may link neuroinflammation and secondary injury after stroke.

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Section: Discussionmentioning

confidence: 55%

Soluble ST2 predicts outcome and hemorrhagic transformation after acute stroke

Wolcott

Batra

Bevers

et al. 2017

Ann Clin Transl Neurol

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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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

Bunevičius

Kazlauskas²,

Raškauskienė³

et al. 2015

Neuroimmunomodulation

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Objective: N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), and interleukin-6 (IL-6) concentrations can be important biomarkers in the acute stroke setting. In acute ischemic and hemorrhagic stroke patients, we investigated the association of NT-proBNP, hsCRP, and IL-6 serum concentrations with stroke severity and functional and cognitive outcomes at discharge. Methods: Seventy-eight patients (53 men; median age 72 years) admitted with ischemic or hemorrhagic stroke within 48 h of symptom onset were evaluated for clinical stroke severity (Scandinavian stroke scale; SSS), functional status before the stroke (modified Rankin scale; mRS), and cerebrovascular disease risk factors. Cognitive (Mini Mental State Examination) and functional (mRS) outcomes were evaluated at hospital discharge. Blood samples were drawn for the assessment of NT-proBNP, hsCRP, and IL-6 concentrations within 24 h of admission. Results: Greater NT-proBNP and hsCRP serum concentrations were associated with greater clinical stroke severity, adjusting for the patients' gender, age, stroke type, mRS score on admission, and presence of heart failure (β = -0.292, p = 0.012; β = -0.303, p = 0.009). In multivariate adjusted regression models with IL-6, hsCRP, and NT-proBNP considered together, IL-6 and hsCRP remained associated with worse functional (β = 0.210, p = 0.022) and cognitive (β = -0.269, p = 0.014) outcomes at discharge, respectively. In receiver operating characteristic analyses, the investigated blood biomarkers produced a minimal increase in predictive values for outcomes at discharge above the SSS score, age, and gender. Conclusions: In acute stroke patients, greater NT-proBNP and hsCRP serum concentrations are independently associated with greater clinical stroke severity. Elevated concentrations of IL-6 and hsCRP are associated with worse functional and cognitive outcomes at discharge, respectively.

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“…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.…”

mentioning

confidence: 99%

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

Stănescu¹,

Dogaru²

2015

BALNEO

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Functional outcome after cardiovascular and cerebrovascular events is traditionally predicted using demographic and clinical variables like age, gender, blood pressure, cholesterol levels, diabetes status, smoking habits or pre-existing morbidity. Identification of new variables will improve the risk stratification of specific categories of patients. Numerous blood-based biomarkers associated with increased cardiovascular risk have been identified; some of them even predict cardiovascular events. Investigators have tried to produce prediction models by incorporating traditional risk factors and biomarkers. (1). Widely-available, rapidly processed and less expensive biomarkers could be used in the future to guide management of complex cerebrovascular patients in order to maximize their recovery (2) Recently, studies have demonstrated that biomarkers can predict not only the risk for a specific clinical event, but also the risk of death of vascular cause and the functional outcome after cardiovascular or cerebrovascular events.Early prediction of fatal outcome after stroke may improve therapeutic strategies (such as the use of more aggressive treatments or inclusion of patients in clinical trials) and guide decision-making processes in order to maximize patient's chances for survival and recovery. (3) Long term functional outcome after stroke is one of the most difficult variables to predict. Elevated serum levels of brain natriuretic peptide (BNP) are powerful predictor of outcomes in patients with cardiovascular disease (heart failure, atrial fibrillation). Potential role of BNP in predicting atrial fibrillation occurrence, cardio-embolic stroke and post-stroke mortality have been proved in many studies. However, data concerning the potential role of BNP in predicting short term and long term functional outcomes after stroke remain controversial.

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

Cited by 45 publications

References 27 publications

Soluble ST2 predicts outcome and hemorrhagic transformation after acute stroke

Soluble ST2 predicts outcome and hemorrhagic transformation after acute stroke

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

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

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