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

Yi Yang,Zhen-Ni Guo,Peng Zhang,Hang Jin,Ke-Jia Zhang,Rui Xu

doi:10.3389/fnmol.2021.758915

Abstract

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are a promising biomarker for predicting stroke outcomes; however, their prognostic validity is not well-understood in patients who have undergone intravenous thrombolysis. This study was designed to evaluate the prognostic value of NT-proBNP levels in patients with acute ischemic stroke treated with intravenous thrombolysis.Methods: Patients with ischemic stroke who underwent intravenous thrombolysis between April 2015 and December 2020 were analyzed. Demographic information, information related to intravenous thrombolysis, medical history, and laboratory test results were collected. Outcomes, such as hemorrhagic transformation, early neurologic deterioration, poor 3-month functional outcomes, and 3-month mortality were recorded. Correlations between NT-proBNP levels and the above outcomes were analyzed, an individualized prediction model based on NT-proBNP levels for functional outcomes was developed, and a nomogram was drafted.Results: A total of 404 patients were included in the study. Elevated NT-proBNP levels were independently associated with hemorrhagic transformation, poor 3-month functional outcomes, and 3-month mortality, while early neurological deterioration was not. An association between NT-proBNP levels and hemorrhagic transformation was noted. An individualized prediction model for poor functional outcomes was established, which was composed of ln(NT-proBNP), National Institutes of Health Stroke Scale (NIHSS), and baseline glucose, with good discrimination [area under the curve (AUC) 0.764] and calibration (P > 0.05).Conclusion: To the best of our knowledge, this is the first report on the association between NT-proBNP levels and hemorrhagic transformation in patients who have undergone intravenous thrombolysis. The 3-month functional outcomes and mortality were found to be associated with NT-proBNP levels. An individualized prediction model based on NT-proBNP levels to predict the 3-month functional outcomes was established. Our results suggest that NT-proBNP levels could be used as a prognostic biomarker in patients with acute ischemic stroke treated with intravenous thrombolysis.

Highlights

N-terminal pro-brain natriuretic peptide (NT-proBNP) is an inactive fragment derived from the cleavage of BNP, which is released by the ventricular myocardium in response to stretching (Daniels and Maisel, 2007)
The diagnosis of acute ischemic stroke was based on baseline symptoms and CT imaging performed before intravenous thrombolysis, which was further confirmed by follow-up CT or MRI
Demographic information [age, sex, body mass index (BMI)], information related to intravenous thrombolysis [onset to needle time (ONT), dosage of Recombinant tissue plasminogen activator (rt-PA), bridging therapy], lifestyle history, medical history [hypertension, diabetes mellitus, atrial fibrillation (AF), and coronary heart disease (CHD)], baseline and 24 h National Institutes of Health Stroke Scale (NIHSS) scores, baseline systolic blood pressure and diastolic blood pressure, baseline fingertip blood glucose, laboratory results [NT-proBNP, low density lipoproteincholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglyceride, total cholesterol, and homocysteine levels] were collected

Summary

Introduction

N-terminal pro-brain natriuretic peptide (NT-proBNP) is an inactive fragment derived from the cleavage of BNP, which is released by the ventricular myocardium in response to stretching (Daniels and Maisel, 2007). Previous studies have reported that NT-proBNP levels are associated with mortality, poor functional outcomes, and stroke-associated complications (Garcia-Berrocoso et al, 2013; Zhao et al, 2020; Faura et al, 2021). We aimed to further investigate the prognostic value of NT-proBNP levels in patients with acute ischemic stroke who received intravenous thrombolysis and to evaluate its association with mortality, functional outcomes, hemorrhagic transformation, and early neurological deterioration. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are a promising biomarker for predicting stroke outcomes; their prognostic validity is not well-understood in patients who have undergone intravenous thrombolysis. This study was designed to evaluate the prognostic value of NT-proBNP levels in patients with acute ischemic stroke treated with intravenous thrombolysis

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