title: Brain natriuretic peptide level on admission predicts recurrent stroke after discharge in stroke survivors with atrial fibrillation.
abstract: OBJECTIVE
  We investigated whether brain natriuretic peptide (BNP) levels could be used as a marker to predict recurrent stroke in ischemic stroke survivors.
  
  
  METHODS
  From April 2007 to March 2011, consecutive patients within 24h of onset of ischemic stroke were prospectively enrolled, and admission plasma BNP levels were measured. Survivors were followed up to 12 months after stroke onset. Patients were divided into two groups: the recurrence group and the non-recurrence group. Factors associated with stroke recurrence were investigated by multiple logistic regression analysis.
  
  
  RESULTS
  A total of 793 patients who were alive at hospital discharge were included; 42 (5%) patients had recurrent stroke. There were no differences in BNP levels between groups. With respect to 257 patients with atrial fibrillation (AF), BNP levels were significantly higher in the recurrence group than in the non-recurrence group (426.0 vs. 192.0 pg/mL, P = 0.0007). The optimal cutoff level, sensitivity, and specificity of BNP levels to distinguish the recurrence group from the non-recurrence group were 300.0 pg/mL, 80%, and 73%, respectively. After adjustment for age and sex, plasma BNP ≥ 300.0 pg/mL (OR, 9.2; 95% CI, 1.87-45.01, P = 0.0062) was found to be independently associated with recurrent stroke in stroke survivors with AF.
  
  
  CONCLUSIONS
  Admission BNP levels can predict recurrent stroke in stroke survivors with AF.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan. Electronic address: shibaken@med.kawasaki-m.ac.jp.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Shibazaki
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Sakai
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Saji
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Uemura
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000097:blood* / Q000150:complications / Q000401:mortality; D002545:Brain Ischemia / Q000097:blood* / Q000150:complications / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000097:blood* / Q000150:complications / Q000401:mortality; D016019:Survival Analysis
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Atrial fibrillation; Brain natriuretic peptide; Ischemic stroke survivors; Predictive marker; Stroke recurrence