Background: Plasma brain natriuretic peptide (BNP) is primarily released from the ventricular myocardium and is a biomarker of cardioembolic stroke. Previous studies have shown that elevated plasma BNP level predicts short and long term mortality in cardioembolic stroke. However, the relationship between BNP and mortality in non-cardioembolic stroke has not been fully examined. The present study tested the hypothesis that admission plasma BNP level can serve as a marker of 3-month mortality in non-cardioembolic stroke.
Methods: From a prospective stroke registry, we examined acute non-cardioembolic stroke patients within 7 days after symptom onset who measured plasma BNP on admission from September 2014 to March 2016. We divided all patients into the non-survivors and the survivors within 3 month of non-cardioembolic stroke, and compared clinical characteristics between the two groups. The factors associated with 3-month mortality were investigated by multivariate logistic regression analysis.
Results: Three hundred and one patients (198 males, 71 [61-80] years old) were enrolled in the study. Thirteen patients (3.8%) died within 3 month of non-cardioembolic stroke. There were no significant differences in male (61.5% vs. 66.0%, P=0.769), age (71 years old vs. 68 years old, P=0.450), hypertension (61.5% vs. 65.6%, P=0.771), diabetes (15.4% vs. 28.7%, P=0.525), dyslipidemia (30.8% vs. 43.4%, P=0.409), and smoking (61.5% vs. 50.0%, P=0.573) between the non-survivors and the survivors. The NIHSS score was significantly higher in the non-survivors than in the survivors (15 vs. 2, P<0.001). The plasma BNP was significantly higher in the group of non-survivors than in the group of survivors (85 pg/ml vs. 31 pg/ml, p =0.005). A cut off plasma BNP level of 65.0 pg/ml could predict death within 3 month of non-cardioembolic stroke. Multivariate logistic regression analysis showed that a plasma BNP level of >65.0 pg/ml (odds ratio [OR] 6.49; 95% confidence interval [CI], 1.79-23.56, P=0.04) was independently associated with 3-month mortality in non-cardioembolic stroke.
Conclusions: A high plasma BNP level on admission should be a predictor for 3-month mortality in non-cadioembolic stroke.