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The role of N-terminal pro-brain natriuretic peptide in evaluating the prognosis of patients with intracerebral hemorrhage

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Abstract

A prognostic biomarker that can provide a good prediction of prognosis in patients with intracerebral hemorrhage (ICH) would be beneficial in guiding the initial management decisions in the setting of ICH. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a biomarker of prognosis in patients with cardiovascular disease and ischemic stroke. However, the prognostic role of NT-proBNP in patients with spontaneous ICH is still a controversial issue. This study aimed to determine the prognostic value of NT-proBNP in patients with spontaneous ICH. A total of 132 patients from 571 ICH cases in inpatient settings were enrolled in this study. Blood samples from each subject were obtained and analyzed for NT-proBNP on admission and on days 4 and 7. The first end point was functional outcome at discharge, which was dichotomized into favorable or unfavorable; the secondary end point was mortality within 6 months after ICH. Compared with the baseline levels on admission after ICH, the NT-proBNP levels increased markedly on day 4 (P < 0.05). Multivariate logistic regression analysis indicated that the NT-proBNP level on day 4, the ICH score, and the APACHE II score were independent prognostic factors of functional outcome and 6-month mortality in ICH patients. A cutoff NT-proBNP level of 999.85 pg/ml predicted an unfavorable functional outcome (with 66.1% sensitivity and 98.7% specificity) and 6-month mortality (with 93.8% sensitivity and 92.0% specificity) in ICH patients. Thus, the NT-proBNP level on day 4 was found to be a powerful prognostic predictor of functional outcome and 6-month mortality in ICH patients, which would be beneficial to guiding the initial management decisions in the setting of ICH.

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References

  1. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Bonet LA, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Orn S, Parissis JT, Ponikowski P, ESC Committee for Practice Guidelines (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 14:803–869

    Article  CAS  PubMed  Google Scholar 

  2. Morrow DA, Cannon CP, Jesse RL, Newby LK, Ravkilde J, Storrow AB, Wu AH, Christenson RH, National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines (2007) National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Circulation 115:e356–e375

    Article  PubMed  Google Scholar 

  3. Lorgis L, Zeller M, Dentan G, Sicard P, Buffet P, L’Huillier I, Beer JC, Vincent-Martin M, Makki H, Gambert P, Cottin Y, RICO Survey Working Group (2009) Prognostic value of N-terminal pro-brain natriuretic peptide in elderly people with acute myocardial infarction: prospective observational study. BMJ 338:b1605

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Hunt PJ, Yandle TG, Nicholls MG, Richards AM, Espiner EA (1995) The amino-terminal portion of pro-brain natriuretic peptide (Pro-BNP) circulates in human plasma. Biochem Biophys Res Commun 214:1175–1183

    Article  CAS  PubMed  Google Scholar 

  5. Xing Wu, Sha Hongying, Sun Yirui, Gao Liang, Liu Hua, Yuan Qiang, Zhang Tao, Zhu Jianhong, Zhou Liangfu, Jin Hu (2011) N-terminal Pro-B-type natriuretic peptide in patients with isolated traumatic brain injury: a prospective Cohort study. J Trauma 71:820–825

    Article  Google Scholar 

  6. Tykocki T, Kostyra K, Bojanowski K, Kostkiewicz B (2014) Analysis of the serum components in acute period after subarachnoid hemorrhage. Turk Neurosurg 24:672–678

    PubMed  Google Scholar 

  7. Chang L, Yan H, Li H, Song Z, Gui Y, Yan Z, Li T, Duan D (2014) N-terminal probrain natriuretic peptide levels as a predictor of functional outcomes in patients with ischemic stroke. NeuroReport 25:985–990

    Article  CAS  PubMed  Google Scholar 

  8. Naveen V, Vengamma B, Mohan A, Vanajakshamma V (2015) N-terminal pro-brain natriuretic peptide levels and short term prognosis in acute ischemic stroke. Ann Indian Acad Neurol 18:435–440

    PubMed  PubMed Central  Google Scholar 

  9. Jensen JK, Mickley H, Bak S, Korsholm L, Kristensen SR (2006) Serial measurements of N-terminal pro-brain natriuretic peptide after acute ischemic stroke. Cerebrovasc Dis 22:439–444

    Article  CAS  PubMed  Google Scholar 

  10. Hajdinjak E, Klemen P, Grmec S (2012) Prognostic value of a single prehospital measurement of N-terminal pro-brain natriuretic peptide and troponin T after acute ischaemic stroke. J Int Med Res 40:768–776

    Article  CAS  PubMed  Google Scholar 

  11. Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology (2015) Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:2032–2060

    Article  PubMed  Google Scholar 

  12. Lei C, Wu B, Liu M, Tan G, Zeng Q (2016) Pathogenesis and subtype of intracerebral hemorrhage (ICH) and ICH score determines prognosis. Curr Neurovasc Res 13:244–248

    Article  PubMed  Google Scholar 

  13. Kwon WK, Park DH, Park KJ, Kang SH, Lee JH, Cho TH, Chung YG (2014) Prognostic factors of clinical outcome after neuronavigation-assisted hematoma drainage in patients with spontaneous intracerebral hemorrhage. Clin Neurol Neurosurg 123:83–89

    Article  PubMed  Google Scholar 

  14. Huang Y, Chen J, Zhong S, Yuan J (2016) Role of APACHE II scoring system in the prediction of severity and outcome of acute intracerebral hemorrhage. Int J Neurosci 126:1020–1024

    Article  CAS  PubMed  Google Scholar 

  15. Levin ER, Gardner DG, Samson WK (1998) Natriuretic peptides. N Engl J Med 339:321–328

    Article  CAS  PubMed  Google Scholar 

  16. Goya Y, Shibazaki K, Sakai K, Aoki J, Uemura J, Saji N, Isa K, Ohya Y, Kimura K (2014) Brain natriuretic peptide upon admission as a biological marker of short-term mortality after intracerebral hemorrhage. Eur Neurol 71:203–207

    Article  CAS  PubMed  Google Scholar 

  17. Nyberg Christoffer, Karlsson Torbjörn, Ronne-Engsrtöm Elisabeth (2014) Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage. J Neurosurg 120:599–604

    Article  CAS  PubMed  Google Scholar 

  18. Li F, Chen QX, Xiang SG, Yuan SZ, Xu XZ (2017) N-terminal pro-brain natriuretic peptide concentrations after hypertensive intracerebral hemorrhage. J Intensive Care Med. doi:10.1177/0885066616683677

    Google Scholar 

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Acknowledgements

We gratefully acknowledge the help of all members of the Department of Neurosurgery, Renmin Hospital of Wuhan University, as well as the patients and their families who participated in the study; their participation and contributions made this study possible.

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Authors and Affiliations

  1. Department of Neurosurgery, Renmin Hospital of Wuhan University, No.99, Zhang Zhidong Road, Wuchang District, Wuhan City, 430060, Hubei Province, China

    Fei Li & Qian-Xue Chen

  2. Department of Intensive Care Unit, Xiangyang Hospital, Hubei University of Medicine, Xiangyang City, Hubei Province, China

    Shou-Gui Xiang

  3. Department of Intensive Care Unit, Wenrong Hospital, Jinhua City, Zhejiang Province, China

    Shi-Zhun Yuan

  4. Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou City, Guangdong Province, China

    Xi-Zhen Xu

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  1. Fei Li
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  2. Qian-Xue Chen
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  3. Shou-Gui Xiang
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  4. Shi-Zhun Yuan
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  5. Xi-Zhen Xu
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Correspondence to Qian-Xue Chen.

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Ethics statement

This study was conducted in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The research protocol was approved by the Medical Ethics Board of the Renmin Hospital of Wuhan University. Informed consent was obtained from all patients or their next of kin.

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The authors confirm that there is no conflict of interest.

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Li, F., Chen, QX., Xiang, SG. et al. The role of N-terminal pro-brain natriuretic peptide in evaluating the prognosis of patients with intracerebral hemorrhage. J Neurol 264, 2081–2087 (2017). https://doi.org/10.1007/s00415-017-8602-0

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  • DOI: https://doi.org/10.1007/s00415-017-8602-0

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