N-terminal proBrain Natriuretic Peptide Levels Predict Short-term Poststroke Survival

Abstract

To investigate the significance of N-terminal proBrain natriuretic peptide (NT-proBNP) in predicting the outcome of acute stroke in relation to other cardiovascular variables and stroke severity. Prospective study of previously independent acute ischemic and hemorrhagic stroke patients admitted to the acute stroke ward. Measurements of NT-proBNP in acute phase in addition to standard assessment of cardiovascular and neurological details. Concentrations and significance of NT-proBNP in patients who were dead versus alive at 120 days after acute stroke and Cox regression analysis with stroke severity measured as Scandinavian Stroke Scale (SSS) and other cardiovascular disease to predict mortality. One hundred fourteen patients were recruited, median age 74 years. At 120 days, 13 patients had died. Deceased patients had a significantly higher concentration of NT-proBNP as compared to alive patients (P < .001). All patients who had died had NT-proBNP concentration above the median for the whole group. Cox regression analysis revealed that NT-proBNP was the most significant independent variable predicting mortality (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.35 to 4.41, P = .003) followed by the SSS (OR 0.95, 95% CI 0.90 to 0.98, P = .005). Higher NT-proBNP and lower SSS predicted mortality. There was a significant negative correlation of NT-proBNP with SSS score (r = -0.24, P = .02). There were no significant difference in NT-proBNP concentrations between ischemic and hemorrhagic strokes (P < .346). At 6 weeks, the dependent patients had higher concentrations of NT-proBNP than independent patients. NT-proBNP, an index of cardiac impairment, has an independent prognostic value in acute stroke patients over other cardiovascular variables and stroke severity. This may provide a channel for interventional therapy in acute stroke.