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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(10): 985-993
DOI: 10.1055/s-0042-1755270
Original Article

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
Wan-Ting Lu 
1   People's Hospital of Xinjiang Uygur Autonomous Region, Department of Neurology, Urumqi, China.
,
Wen-Ting Du 
1   People's Hospital of Xinjiang Uygur Autonomous Region, Department of Neurology, Urumqi, China.
2   Xinjiang Medical University, Department of Postgraduate, Urumqi, China.
,
De-Sheng Lu 
3   Shihezi People's Hospital, Department of Neurosurgery, Shihezi, China.
,
Jie You 
2   Xinjiang Medical University, Department of Postgraduate, Urumqi, China.
,
Hong-yan Li 
1   People's Hospital of Xinjiang Uygur Autonomous Region, Department of Neurology, Urumqi, China.
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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.

Resumo

Antecedentes O peptídeo natriurético cerebral (BNP, na sigla em inglês) e a troponina estão intimamente relacionados com a embolia cerebral cardiogênica (CCE, na sigla em inglês), mas a relação com pacientes não cardioembólicos com isquemia de circulação anterior (ICA) e isquemia de circulação posterior (ICP) não é clara.

Objetivo Investigar o valor preditivo dos níveis séricos iniciais do BNP e da troponina no prognóstico de pacientes com AVC isquêmico não cardiogênico.

Métodos Os níveis séricos de BNP e de troponina foram recolhidos de pacientes com primeiro episódio de acidente vascular cerebral (AVC) isquêmico dentro de 12 horas após o início dos sintomas, com localização classificada como ICA e ICP de acordo com exame de ressonância magnética (RM). De acordo com a pontuação modificada da escala de Rankin (mRS), aos 90 dias após o início dos sintomas, ICA e ICP foram divididas respectivamente em um grupo de bom prognóstico (mRS entre 0 e2) e em um grupo de mau prognóstico (mRS entre 3 e 6). Foram registrados exames laboratoriais e outros exames complementares de todos os pacientes. Foram utilizadas análise fatorial única e análise de regressão logística multivariada para investigar a relação entre os níveis séricos de BNP e de troponina e o resultado funcional.

Resultados A regressão logística multivariada evidenciou que os níveis mais altos de BNP inicial (odds ratio [OR] = 1,024, intervalo de confiança [IC] de 95%: 1,006–1,041; p = 0,007) e proteína C reativa (CRP, na sigla em inglês) (OR = 1,184; 95%CI: 1,024–1,369; p = 0,022) foram preditores independentes de mau prognóstico funcional da ICP não cardiogênica aos 90 dias após o início dos sintomas.

Conclusões Os níveis iniciais de BNP e CRP se associaram a maus resultados funcionais em pacientes com ICP não cardiogênica aos três meses, independentemente da troponina.

Keywords

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

Palavras-chave

Infarto da Artéria Cerebral Anterior - Infarto Encefálico - Peptídeo Natriurético Encefálico - Troponina - Proteína C-Reativa - Prognóstico - Embolia

Authors' Contributions

WTL: Participated in the study design and coordination; performed most of the experiments, analysis and interpretation of data; performed the statistical analysis and drafted the manuscript; WTD: Made the figures and drafted the manuscript; DSL: Participated in the statistical analysis and in the language polishing of the final version; JY: Carried out the experiments and sample collection; HYL: participated in the study design and coordination, conceptualization and methodology, material support for supervised study.




Publikationsverlauf

Eingereicht: 17. Juni 2021

Angenommen: 09. September 2021

Artikel online veröffentlicht:
19. Dezember 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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