Plasma brain natriuretic peptide as an independent predictor of in-hospital mortality after acute ischemic stroke.
OBJECTIVE
We investigated whether the plasma brain natriuretic peptide (BNP) level on admission can serve as a biological marker of in-hospital death in patients with acute ischemic stroke.


METHODS
We prospectively enrolled 335 consecutive patients (125 females; mean age, 72.3 years) with acute ischemic stroke within 24 hours of onset and measured plasma BNP on admission. Patients were divided into two groups: the deceased group, who died during hospitalization; and the survival group. The factors associated with in-hospital death were investigated by multivariate logistic regression analysis.


RESULTS
Death was observed in 20 (6.0%) patients. Frequencies of atrial fibrillation, cardioembolism, the use of diuretics before ischemic stroke, the use of digitalis before ischemic stroke, National Institutes of Health Stroke Scale (NIHSS) score on admission, glucose level, and D-dimer were significantly higher in the deceased group than in the survival group. On the other hand, albumin was significantly lower in the deceased group than in the survival group. The mean +/- SD of the plasma BNP level of the deceased group was significantly higher than that of the survival group (731.5+/-1,070.9 vs. 213.1+/-384.5 pg/mL, p=0.001). The optimal cut-off level, sensitivity, and specificity of BNP levels to distinguish the deceased group from the survival group were 240 pg/mL, 75.0% and 73.0%, respectively. Multivariate logistic regression analysis demonstrated that a NIHSS score of >13 (odds ratio [OR], 4.87; 95% confidence interval, 1.54 to 15.44, p=0.007) and plasma BNP level of >240 pg/mL (OR, 4.67; 95% confidence interval, 1.28 to 17.09, p=0.020) were independent factors associated with in-hospital death.


CONCLUSIONS
The plasma BNP level on admission can predict in-hospital death in patients with acute ischemic stroke.
Shibazaki
Kensaku
K
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan. shibaken@med.kawasaki-m.ac.jp
Kimura
Kazumi
K
Okada
Yoko
Y
Iguchi
Yasuyuki
Y
Uemura
Jyunichi
J
Terasawa
Yuka
Y
Aoki
Junya
J
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000209:etiology / Q000401:mortality*; D016019:Survival Analysis
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain