Elevated N-terminal pro-brain-type natriuretic peptide at admission is associated with unfavorable outcomes after aneurysmal subarachnoid hemorrhage

Abstract

Cardiac injury and dysfunction following aneurysmal subarachnoid hemorrhage (aSAH) negatively impact the neurological outcomes. This study aimed to determine the association between N-terminal pro-brain-type natriuretic peptide (NT-pro BNP) levels at admission and neurological outcomes at six months in aSAH patients following endovascular treatment. Patients diagnosed with aSAH who underwent NT-pro BNP measurement at admission at our department between January 2018 and April 2021 were retrospectively analyzed. Neurological outcomes were evaluated based on the six-month modified Rankin Scale score. The associations between admission NT-pro BNP levels and neurological outcomes were investigated. In total, 471 patients were included in the analysis. The serum NT-pro BNP levels were significantly lower in patients with a favorable outcome than those with an unfavorable outcome. The area under the receiver operating characteristic curve (AUC) of NT-pro BNP was 0.687. The optimal cutoff value of serum NT-pro BNP level as a predictor of unfavorable outcome was 253.4 pg/mL. Multivariate analysis revealed that admission NT-pro BNP level of >253.4 pg/mL was significantly associated with unfavorable outcomes. After propensity score-matching, admission NT-pro BNP level of >253.4 pg/mL was an independent predictor of unfavorable outcomes. Admission NT-pro BNP level added a slight value to other clinical variables for the prediction of unfavorable outcomes (0.877 vs 0.871 in AUC, respectively; p = 0.084). In conclusion, higher admission NT-pro BNP levels were independently associated with six-month unfavorable outcomes in aSAH patients treated with endovascular treatment. However, it added only minor prognostic value to clinical information alone.