Predictive value of serum initial brain natriuretic peptide and troponin on functional prognosis in noncardiogenic patients with anterior and posterior circulation cerebral infarction

Lu, Wan-Ting; Du, Wen-Ting; Lu, De-Sheng; You, Jie; Li, Hong-yan

doi:10.1055/s-0042-1755270

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Original Article • Arq. Neuro-Psiquiatr. 80 (10) • 2022 • https://doi.org/10.1055/s-0042-1755270 copy

Predictive value of serum initial brain natriuretic peptide and troponin on functional prognosis in noncardiogenic patients with anterior and posterior circulation cerebral infarction

Valor preditivo dos níveis séricos iniciais do peptídeo natriurético cerebral e da troponina no prognóstico funcional em pacientes não cardiogênicos com acidente vascular cerebral isquêmico de circulação anterior e posterior

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Brain natriuretic peptide (BNP) and troponin have a close relationship with cardiogenic cerebral embolism (CCE), but their relationship with noncardiogenic patients with anterior circulation ischemia (ACI) and posterior circulation ischemia (PCI) is not clear.

Objective

To explore the predictive value of serum initial BNP and troponin on the functional prognosis of patients with noncardiogenic ACI and PCI.

Methods

Consecutive patients with first-episode cerebral infarction within 12 hours of symptom onset were enrolled in the present 1-year prospective cohort study. Serum levels of BNP and troponin were collected within 12 hours of onset. Infarction location was classified as ACI and PCI by magnetic resonance imaging (MRI). According to the modified Rankin Scale (mRS) score at 90 days after onset, ACI and PCI cases were respectively divided into a good prognosis group (mRS score between 0 and 2) and a poor prognosis group (mRS score between 3 and 6). The general state of health and results of laboratory examinations and other auxiliary examinations of all patients were recorded. Single-factor analysis and multivariate logistic regression analysis were used to assess the relationship between serum levels of BNP, troponin, and functional outcome.

Results

The multivariate logistic regression found that higher levels of initial BNP (odds ratio [OR] = 1.024; 95% confidence interval [CI]: 1.006–1.041; p = 0.007) and C-reactive protein (CRP) (OR = 1.184; 95%CI: 1.024–1.369; p = 0.022) were independent predictors of poor functional prognosis of noncardiogenic PCI at 90 days after onset after adjusting for age, gender, ethnicity, history of hypertension and of diabetes.

Conclusions

The levels of initial BNP and CRP were related to poor functional outcomes in noncardiogenic PCI patients at 3 months, independent of troponin.

Keywords
Infarction, Anterior Cerebral Artery; Brain Infarction; Natriuretic Peptide, Brain; Troponin; C-Reactive Protein; Prognosis; Embolism

	Total	Good prognosis	Poor prognosis	p-value
n	69	47	22	−
Age, years od $\bar{x} \pm SD$		60.24 ± 13.92	67.14 ± 14.02	0.201
Sex, n (%)		(23/24)	(7/15)	0.303
BMI, kg/m2, $\bar{x} \pm SD$		26.72 ± 3.19	25.88 ± 3.72	0.577
Smoking, n (%)		24 (51.6)	14 (63.6)	0.901
Drinking, n (%)		7 (2.1)	1 (4.5)	0.712
Prior vascular risk factors, n (%)
Hypertension		30 (63.8)	11 (50.0)	0.672
Diabetes mellitus		27 (57.4)	10 (79.1)	0.702
Hypercholesterolemia		39 (70.9)	15 (45.4)	0.603
NIHSS at admission, median (IQR)		6.00 (1.00–15.00)	13.50 (7.00, 15.00)	0.031
GCS at admission, $\bar{x} \pm SD$		7.72 ± 6.231	10.92 ± 6.723	0.192
Stroke subtype				0.238
Large artery atherosclerosis	37	27 (57.4)	10 (45.4)
Small vessel occlusion	32	25 (53.1)	7 (31.8)
Laboratory findings
BNP, pg/nl		25.4 (13.45–77.26)	32.20 (13.10–149.80)	0.353
cTnI, ng/L		0.01 (0.003–0.012)	0.004 (0.003–0.012)	0.319
cTnT, ng/L		0.012 (0.007–0.022)	0.011 (0.007–0.022)	0.791
IL-6, mmol/L		4.40 (2.855–6.895)	6.63 (4.53–11.29)	0.031
Glucose level, mmol/L		6.53 (5.715–9.41)	7.670 (6.00–9.23)	0.704
BUN, mg/L		5.50 (4.20–7.05)	5.62 (4.90–7.20)	0.425
Cr, mg/L		63.90 (51.40–76.10)	63.80 (56.20–74.60)	0.872
TBIL, μmol/L		12.50 (7.59–16.50)	13.285 (10.36–19.00)	0.135
ALT, U/L		18.00 (11.50–28.00)	18.50 (14.00–30.00)	0.602
GOT, U/L		16.00 (13.00–25.00)	18.50 (14.00–27.00)	0.523
D-dimer, mg/l		0.30 (0.23–0.525)	0.53 (0.29–1.27)	0.053
CRP, mg/l		3.51 (2.50–6.66)	6.365 (2.51–13.80)	0.041

	Total	Good prognosis	Poor prognosis	p-value
n	79	55	24	−
Age, years old $\bar{x} \pm SD$		59.44 ± 14.977	65.21 ± 13.609	0.113
Sex, n (%)		(30/25)	(9/15)	0.132
BMI, kg/m2, $\bar{x} \pm SD$		25.77 ± 4.23	24.92 ± 3.69	0.242
Smoking, n (%)		13 (23.6)	6 (25)	0.721
Drinking, n (%)		5 (9.0)	1 (4.0)	0.820
Prior vascular risk factors, n (%)
Hypertension		37 (67.2)	20 (83.3)	0.954
Diabetes mellitus		18 (32.7)	19 (79.1)	0.702
Hypercholesterolemia		39 (70.9)	15 (62.5)	0.532
NIHSS at admission, median (IQR)		3.00 (1.00–15.00)	9.50 (2.50–14.50)	0.456
GCS at admission, $\bar{x} \pm SD$		9.91 ± 6.631	11.83 ± 5.623	0.192
Stroke subtype				0.102
Large artery atherosclerosis	49	38 (69.0)	11 (45.8)
Small vessel occlusion	30	22 (40.0)	8 (33.3)
Laboratory findings
BNP, pg/nl		27.20 (10.50–71.90)	134.60 (60.65–190.21)	0.000
cTnI, ng/L		0.005 (0.002–0.012)	0.011 (0.005–0.013)	0.034
cTnT, ng/L		0.009 (0.007–0.014)	0.015 (0.009–0.019)	0.013
IL-6, mmol/L		3.75 (2.31–5.95)	9.82 (7.78–24.50)	0.000
Glucose level, mmol/L		6.36 (5.62–8.11)	7.15 (6.00–9.65)	0.200
BUN, mg/L		5.30 (4.43–6.05)	6.15 (4.20–8.10)	0.166
Cr, mg/L		63.50 (54.75–69.95)	62.30 (5′0.80–84.75)	0.721
TBIL, μmol/L		13.37 (10.24–19.01)	13.98 (7.97–19.85)	0.737
ALT, U/L		23.00 (17.00–31.00)	15.00 (8.50–20.00)	0.001
GOT, U/L		20.00 (15.50–24.00)	16.50 (13.99–21.00)	0.039
D-dimer, mg/l		0.31 (0.21–0.47)	0.720 (0.39–1.22)	0.000
CRP, mg/l		2.50 (2.41–4.15)	5.30 (3.00–12.53)	0.002

	OR	95%CI	p-value
NIHSS at admission	1.095	0.999–1.201	0.054
IL-6, mmol/L	0.974	0.897–1.057	0.527
CRP, mg/l	0.057	0.977–1.147	0.164

	OR	95%CI	p-value
BNP, pg/nl	1.024	1.006–1.041	0.007
cTnI, ng/L	1.986	0–4.293	0.452
cTnT, ng/L	0.000	0–3.918	0.639
IL-6, mmol/L	1.089	0.98–1.21	0.113
ALT, U/L	0.961	0.837–1.104	0.574
GOT, U/L	0.981	0.785–1.226	0.864
D-Dimer, mg/l	1.197	0.546–2.624	0.654
CRP, mg/l	1.184	1.024–1.369	0.022

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[1] Address for correspondence Hong-yan Li (e-mail: lhyxxy@126.com).