Brain Natriuretic Peptide upon Admission as a Biological Marker of Short-Term Mortality after Intracerebral Hemorrhage

AbstractThe association between early glycemic change and short-term mortality in non-diabetic patients with acute intracerebral hemorrhage (ICH) is unclear. We retrospectively investigated non-diabetic patients with lobar (n = 262) and non-lobar ICH (n = 370). Each patient had a random serum glucose test on hospital admission and a fasting serum glucose test within the following 48 h. Hyperglycemia was defined as serum glucose ≥ 7.8 mmol/l. Four patterns were determined: no hyperglycemia (reference category), persistent hyperglycemia, delayed hyperglycemia, and decreasing hyperglycemia. Associations with 30-day mortality were estimated using Cox models adjusted for major features of ICH severity. Persistent hyperglycemia was associated with 30-day mortality in both lobar (HR 3.00; 95% CI 1.28–7.02) and non-lobar ICH (HR 4.95; 95% CI 2.20–11.09). In lobar ICH, 30-day mortality was also associated with delayed (HR 4.10; 95% CI 1.77–9.49) and decreasing hyperglycemia (HR 2.01, 95% CI 1.09–3.70). These findings were confirmed in Cox models using glycemic change (fasting minus random serum glucose) as a continuous variable. Our study shows that, in non-diabetic patients with ICH, early persistent hyperglycemia is an independent predictor of short-term mortality regardless of hematoma location. Moreover, in non-diabetic patients with lobar ICH, both a positive and a negative glycemic change are associated with short-term mortality.

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Abstract WP206: Brain Natriuretic Peptide Should Be A Predictive Marker Of Long-term Mortality In Ischemic Stroke Survivors

Stroke ◽

10.1161/str.44.suppl_1.awp206 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Kensaku Shibazaki ◽

Kazumi Kimura ◽

Shuichi Fujii ◽

Kenichiro Sakai ◽

Jyunya Aoki

Keyword(s):

Ischemic Stroke ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Multiple Logistic Regression Analysis ◽

Biological Marker ◽

Predictive Marker ◽

Stroke Survivors ◽

Survival Group ◽

Long Term Mortality

Background and Purpose We investigated whether brain natriuretic peptide (BNP) can serve as a biological marker of long-term mortality in ischemic stroke survivors. Methods We prospectively enrolled consecutive patients with ischemic stroke within 24 hours of onset from April 2007 to December 2010 and measured plasma BNP upon admission. Survivors were followed up to 12 month after stroke onset. Patients were divided into two groups: the deceased group and the survival group. The factors associated with long-term mortality were investigated by multiple logistic regression analysis. Results A total of 736 patients who were alive at hospital discharge were included (mean age, 72.8 years; 439 males). Death was observed in 130 (17.7%) patients. The median (interquartile range: IQR) of age (81(74-86) years for the deceased group vs. 72 (64-79) years for the survival group, P<0.0001), frequencies of prior ischemic stroke (30% vs. 20%, P=0.0104), hemodialysis (10% vs. 2%, P=0.0002), atrial fibrillation (42% vs. 30%, P=0.0058), mRS score at discharge (4 (3-5) vs. 2 (1-4), P<0.0001), cardioembolism (45% vs. 34%, P=0.0102), creatinine level (0.80 (0.60-1.19) vs. 0.73 (0.58-0.90), P=0.0044), and BNP level (170.0 (74.0-393.0) vs. 50.0 (19.0-146.0) pg/ml, P<0.0001) were significantly higher in the deceased group than in the survival group. In multivariate analysis, age >75 years (odds ratio [OR], 2.89; 95%CI, 1.80-4.65, P=0.0001), hemidialysis (OR, 6.59; 95%CI, 2.47-17.59, P=0.0002), mRS score >3 at discharge (OR, 4.39; 95%CI, 2.77-6.97, P<0.0001), and a plasma BNP >100.0 pg/ml (OR, 3.98; 95%CI, 2.35-6.72, P<0.0001) were found to be independently associated with long-term mortality. BNP remained independent predictors of long-term mortality not only cardioembolism [BNP >200.0pg/ml (OR, 2.45; 95%CI, 1.22-4.90, P=0.0114)] but also non-cardioembolism [BNP >50.0pg/ml (OR, 4.01; 95%CI, 2.15-7.48, P=0.0001)]. Thus, the mortality rate according to the BNP level was as follows: 6% of patients with <50 pg/ml, 16% with 50 to <100 pg/ml, 27% with 100 to <200 pg/ml, 28% with 200 to <400 pg/ml, and 45% with ≥400 pg/ml. Conclusions BNP level upon admission can predict long-term mortality in ischemic stroke survivors.

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N-terminal Pro-brain Natriuretic Peptide plasma levels are Associated With a Short-Term Diagnosis of Cancer in Patients with Coronary Artery Disease

10.21203/rs.3.rs-135088/v1 ◽

2020 ◽

Author(s):

José Tuñón ◽

Álvaro Aceña ◽

Ana Pello ◽

Sergio Ramos-Cillán ◽

Juan Martínez-Milla ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Plasma Levels ◽

High Sensitivity ◽

Short Term ◽

Artery Disease

Abstract Background N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels are increased in patients with cancer. In this paper we test whether NT-proBNP may identify patients who are going to receive a future cancer diagnosis (CD) in the short term. Methods We studied 962 patients with stable coronary artery disease and free of cancer and heart failure at baseline. NT-proBNP, galectin-3, monocyte chemoattractant protein-1, high-sensitivity C-reactive protein, high-sensitivity cardiac troponin I (hsTnI), and calcidiol (vitamin D) plasma levels were assessed. The primary outcome was new CD. Results After 5.40 (2.81-6.94) years of follow-up, 59 patients received a CD. NT-proBNP [HR 1.036 CI (1.015-1.056) per increase in 100 pg/ml; p=0.001], previous atrial fibrillation [HR 3.140 CI (1.196-8.243); p=0.020], and absence of previous heart failure [HR 0.067 CI (0.006-0.802); p=0.033] were independent predictors of a receiving a CD in first three years of follow-up. None of the variables analyzed predicted a CD beyond this time. A previous history of heart failure was present in 3.3% of patients receiving a CD in the first three years of follow-up, in 0.0% of those receiving this diagnosis beyond three years, and in 12.3% of patients not developing cancer (p=0.036). Conclusions In patients with coronary artery disease, NT-proBNP is an independent predictor of CD in the first three years of follow-up but not later, suggesting that it could be detecting subclinical undiagnosed cancers. The existence of previous heart failure does not account for these differences. New studies in large populations are needed to confirm these findings.

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N-terminal Pro-brain Natriuretic Peptide plasma levels are Associated With a Short-Term Diagnosis of Cancer in Patients with Coronary Artery Disease

Authorea ◽

10.22541/au.158678690.02403743 ◽

2020 ◽

Author(s):

Jose Tu on ◽

Alvaro Ace a ◽

Ana Pello ◽

Sergio Ramos Cillan ◽

Juan Mart nez Milla ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Plasma Levels ◽

Short Term ◽

Diagnosis Of Cancer ◽

Artery Disease

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Abstract P411: Prevalence, Characteristics and Outcomes of Undetermined Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Stroke ◽

10.1161/str.52.suppl_1.p411 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Konark MALHOTRA ◽

Christina Zompola ◽

Aikaterini Theodorou ◽

Aristeidis Katsanos ◽

Ashkan Shoamanesh ◽

...

Keyword(s):

Systematic Review ◽

Intracerebral Hemorrhage ◽

Meta Analysis ◽

Amyloid Angiopathy ◽

Short Term ◽

Pooled Prevalence ◽

Subgroup Analyses ◽

Short Term Mortality ◽

Cerebral Amyloid ◽

Undetermined Etiology

Objective: We sought to determine the prevalence, radiological characteristics, and clinical outcomes of intracerebral hemorrhage (ICH) of undetermined etiology. Methods: Systematic review and meta-analysis of studies involving patients with spontaneous ICH was conducted to assess the prevalence and clinical-radiological characteristics of undetermined ICH. Additionally, we assessed the rates for ICH secondary to hypertensive arteriopathy (HTN-A) and cerebral amyloid angiopathy (CAA). Subgroup analyses were performed based on the use of a) etiology-oriented ICH classification, b) detailed neuroimaging, and c) Boston criteria among CAA-ICH. Results: 24 studies were included (n=15,828; mean age: 64.8 years, males: 60.8%). The pooled prevalence of HTN-A ICH, undetermined ICH and CAA-ICH were 50% (95%CI: 43-58%), 18% (95%CI: 13-23%), and 12% (95%CI: 7-17%; p<0.001 between subgroups). The volume of ICH was largest in CAA-ICH 24.7mL (95%CI: 19.7-29.8mL), followed by HTN-A ICH 16.2mL (95%CI: 10.9-21.5mL) and undetermined ICH 15.4mL (95%CI: 6.2-24.5mL). Among patients with undetermined ICH, the rates of short-term mortality and intraventricular hemorrhage were 33% (95%CI: 25-42%) and 38% (95%CI: 28-48%), respectively. Subgroup analysis demonstrated a higher rate of undetermined ICH among studies that did not use an etiology-oriented classification (22%; 95%CI: 15-29%). No difference was observed between studies based on the completion of detailed neuroimaging to assess the rates of undetermined ICH (p=0.62). Conclusions: The etiology of spontaneous ICH remains undetermined among one in five patients in studies using etiology-oriented classification and among one in four patients in studies that avoid using etiology-oriented classification. The short-term mortality in undetermined ICH is high despite the relatively small ICH volume. Our findings suggest the use of etiology-oriented classification to approach ICH patients (Figure).

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N-Terminal Pro-Brain Natriuretic Peptide Concentrations After Hypertensive Intracerebral Hemorrhage: Relationship With Hematoma Size, Hyponatremia, and Intracranial Pressure

Journal of Intensive Care Medicine ◽

10.1177/0885066616683677 ◽

2017 ◽

Vol 33 (12) ◽

pp. 663-670 ◽

Cited By ~ 3

Author(s):

Fei Li ◽

Qian-Xue Chen ◽

Shou-Gui Xiang ◽

Shi-Zhun Yuan ◽

Xi-Zhen Xu

Keyword(s):

Intracranial Pressure ◽

Intracerebral Hemorrhage ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Linear Regression Analysis ◽

Peak Level ◽

Hematoma Volume ◽

The Mean ◽

Hypertensive Intracerebral Hemorrhage ◽

Mean Concentration

Introduction: The role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with hypertensive intracerebral hemorrhage (HICH) is poorly understood. This study aimed to investigate the secretion pattern of NT-proBNP in patients with HICH and to assess its relationship with hematoma size, hyponatremia, and intracranial pressure (ICP). Methods: This prospective study enrolled 147 isolated patients with HICH. Blood samples were obtained from each patient, and values of serum NT-proBNP, hematoma size, blood sodium, and ICP were collected for each patient. Results: The peak-to-mean concentration of NT-proBNP was 666.8 ± 355.1 pg/mL observed on day 4. The NT-proBNP levels in patients with hematoma volume >30 mL were significantly higher than those in patients with hematoma volume <30 mL ( P < .05). In patients with severe HICH, the mean concentration of NT-proBNP was statistically higher than that in patients with mild–moderate HICH ( P < .05), and the mean level of NT-proBNP in hyponatremia group was significantly higher than that in normonatremic group ( P < .05). In addition, the linear regression analysis indicated that serum NT-proBNP concentrations were positively correlated with ICP ( r = .703, P < .05) but negatively with blood sodium levels only in patients with severe HICH ( r = −.704, P < .05). The serum NT-proBNP levels on day 4 after admission were positively correlated with hematoma size ( r = .702, P < .05). Conclusion: The NT-proBNP concentrations were elevated progressively and markedly at least in the first 4 days after HICH and reached a peak level on the fourth day. The NT-proBNP levels on day 4 were positively correlated with hematoma size. There was a notable positive correlation between plasma NT-proBNP levels and ICP in patients with severe HICH. Furthermore, only in patients with severe HICH, the plasma NT-proBNP levels presented a significant correlation with hyponatremia, which did not occur in patients with mild–moderate HICH.

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