The role of N-terminal pro-brain natriuretic peptide in evaluating the prognosis of patients with intracerebral hemorrhage

Abstract

A prognostic biomarker that can provide a good prediction of prognosis in patients with intracerebral hemorrhage (ICH) would be beneficial in guiding the initial management decisions in the setting of ICH. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a biomarker of prognosis in patients with cardiovascular disease and ischemic stroke. However, the prognostic role of NT-proBNP in patients with spontaneous ICH is still a controversial issue. This study aimed to determine the prognostic value of NT-proBNP in patients with spontaneous ICH. A total of 132 patients from 571 ICH cases in inpatient settings were enrolled in this study. Blood samples from each subject were obtained and analyzed for NT-proBNP on admission and on days 4 and 7. The first end point was functional outcome at discharge, which was dichotomized into favorable or unfavorable; the secondary end point was mortality within 6 months after ICH. Compared with the baseline levels on admission after ICH, the NT-proBNP levels increased markedly on day 4 (P < 0.05). Multivariate logistic regression analysis indicated that the NT-proBNP level on day 4, the ICH score, and the APACHE II score were independent prognostic factors of functional outcome and 6-month mortality in ICH patients. A cutoff NT-proBNP level of 999.85 pg/ml predicted an unfavorable functional outcome (with 66.1% sensitivity and 98.7% specificity) and 6-month mortality (with 93.8% sensitivity and 92.0% specificity) in ICH patients. Thus, the NT-proBNP level on day 4 was found to be a powerful prognostic predictor of functional outcome and 6-month mortality in ICH patients, which would be beneficial to guiding the initial management decisions in the setting of ICH.

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

“…Hemorrhagic transformation could impact subsequent antiplatelet treatments; severe symptomatic intracranial hemorrhage could be associated with a mortality rate of up to 50% (National Institute of Neurological Disorders and Stroke rt-Pa Stroke Study Group, 1995;Yaghi et al, 2014). The association between elevated NT-proBNP levels and intracerebral hemorrhage has been demonstrated in previous studies (Di Castelnuovo et al, 2019), and elevated NT-proBNP levels were associated with a larger volume of hematoma and poor outcomes (Li et al, 2017(Li et al, , 2018. Our findings demonstrate that NT-proBNP levels are independently associated with hemorrhagic transformation in patients with stroke who have undergone intravenous thrombolysis.…”

Association of Natriuretic Peptide With Adverse Outcomes and Disease Severity After Intracerebral Hemorrhage: A Systematic Review

“…After eliminating duplications, 1,125 articles were retained, of which 1,097 were excluded due to irrelevant titles and abstracts. The full texts of the remaining 28 articles were reviewed for inclusion, and 10 studies (18)(19)(20)(25)(26)(27)(28)(29)(30)(31) fulfilled the inclusion criteria for systematic review. The detailed process of study screening is shown in Figure 1.…”

“…Five studies (18-20, 26, 28) including 980 participants provided the data on all-cause mortality outcome, indicating a correlation with BNP/NT-proBNP level. Among them, four studies (18,19,26,28) found consistently higher levels of BNP/NT-proBNP in non-survivors compared with survivors (range of means: 99.9-1986.48 vs. 32.4-432.38 pg/ml; P < 0.05). Three studies reported multivariate logistic regression analysis to assess risk estimate.…”

“…These three studies were all short-term follow-up (hospital discharge or 3 months). One study (25) Only one study (19) reported a ROC curve for the predictive utility of NT-proBNP level with respect to poor functional outcome. The AUC was 0.838, and applying an NT-proBNP cutoff value of 999.85 pg/ml gave sensitivity and specificity of 66.1% and 98.7%, respectively.…”

“…Therefore, BNP/NT-proBNP may associated with the prognosis of ICH. Over the past decade, many studies have reported the correlation between BNP/NT-proBNP levels and clinical outcome of ICH patients (18)(19)(20). However, the role in assessment of mortality risk and poor functional outcome after ICH remains controversial.…”