| Background: Stroke is also known as cerebrovascular accident(CVA),and it is an acute cerebrovascular disease caused by a blockage of the blood vessels in the brain or a sudden rupture of the blood vessels.A sudden rupture could cause blood to flow into the brain and brain damage.Stroke has two types,ischemic stroke and hemorrhagic stroke.Stroke has obvious three high(high incidence,high morbidity and high mortality)phenomenon,because of acute onset,poor prognosis,and it is the world widely leading cause of severe disability and death and the leading cause of disability in Chinese adults.The incidence rate of stroke in China was rising year by year.Therefore,early detection of predictors of stroke prognosis has important clinical implications for the treatment of stroke and the reduction of disability and mortality.This study was to investigate the relationship between serum NT-pro BNP levels of acute stroke patients and the severity of nerve injury(admission NIHSS score)and short-term prognosis(3 months after discharge mRS score),and to provide the evidence for stroke treatment and prognosis.Objective: By investigating the NIHSS score level on admission among the acute stroke patients with different serum NT-proBNP levels,to explore the relationship between the level of NT-proBNP and neurological severity in patients with acute stroke;To explore the effect of serum NT-proBNP level on the short-term prognosis of stroke,through analyzing the relationship between mRS score at 3 months after discharge and NT-proBNP levels on admission.Methods: From June 1,2014 to June 30,2016,clinical data of acute stroke patients was collected in the Traditional Chinese Medicine Hospital of Kunshan and the First People’s Hospital of Kunshan,All cases were diagnosed in line with the Fourth National Conference on cerebrovascular disease standards,and confirmed by the head computer scanning(CT)or magnetic resonance imaging(MRI)examination.After excluding acute myocardial infarction and angina pectoris patients,patients with acute and chronic heart failure and liver and kidney dysfunction,a total of 674 people were included in this analysis.All patients’ age and sex,disease history,lifestyle and other baseline data were collected on admission,and fasting serum NT-proBNP,fasting blood glucose(GLU),total cholesterol(TG),triglyceride(TC),creatinine(CREA),uric acid(UA)and other indicators were detected,and the neurological function score at admission was assessed using the National Institute of Health stroke scale(NIHSS),the modified Rankin Scale(mRS)at 3 months after discharge was used to evaluate the outcome of the damaged nerve function.According to the mRS scores,patients with mRS≤2 was as a good prognosis group,and patients with mRS >2 as a poor prognosis group.According to the cutoff value of NT-proBNP> 100pg/m L among aged <65 and NT-proBN> 300 pg / m L among aged≥65,the participants were divided into the normal NT-pro BN group and elevated group.Results: Among 674 patients with acute stroke,367(54.5%)were males and 307(45.5%)were females.The mean age was 71.30±12.00 years old,and the median serum NT-pro BNP level was 259.25pg/mL(80.90-1100.25 pg/m L).1.The NT-proBNP level(1019.00pg/m L vs 72.80pg/m L,P<0.001),NIHSS score(8 vs 3,P<0.001)and mRS score(3 vs 1,P<0.001)in the elevated Nt-probnp group were higher than those in the normal group.2.The NT-proBNP level(905.50 pg/mL vs 159.20 pg/m L,P<0.001)and NIHSS score(12 vs 2,P<0.001)in the poor prognosis group were higher than those in the good prognosis group,and there was statistical significance.3.Serum NT-pro BNP levels were positively correlated with admission NIHSS score(r=0.415,p<0.001),and mRS score(r=0.439,p<0.001)at 3 months after discharge(p<0.001).4.Univariate Logistic regression showed that the elevated serum NT-proBNP had higher risk of stroke poor prognosis than the normal level of NT-pro BNP,with the OR of 5.058(95%CI=3.570-7.165).And multiple logistic regression results showed that the elevated serum level of NT-pro BNP still increased the risk of adverse outcomes of stroke patients(OR=3.334,95%CI=2.186-5.087),after adjustment of gender,age(more than 65),heart disease,hypertension,hyperglycemia,admission NIHSS score and so on.5.ROC curve analysis was used to calculate the optimal cutoff point of NT-pro BNP level of distinguishing the poor prognosis and good prognosis of stoke,and the sensitivity was 73.9%,the specificity was 65.5% and the area under the curve was 0.742 when the cutoff point of NT-proBNP level was 267.15 pg/mL.When the cut-off value of NT-proBNP level distinguishing the death group and survival was 1535.50 pg/m L,the sensitivity was 75.0%,specificity was 84.8%,the area under the curve was 0.871.Conclusion:1.There was a positive correlation between serum NT-proBNP level and NIHSS score on admission and mRS score at 3 months after discharge,that is,the higher the level of serum NT-proBNP,the higher the degree of nerve injury(NIHSS score),the worse the prognosis(mRS score)is.2.Patients with high serum NT-proBNP level have a higher risk of poor prognosis,and the elevated serum NT-proBNP level is an independent risk factor for the poor prognosis of stroke,which can be used as an important indicator of disease assessment and prognosis in acute stroke.3.The optimal cut-off point of NT-proBNP level is 267.15pg/m L for distinguishing the poor prognosis and good prognosis group,and which is 1535.50pg/m L for distinguishing the death group and survival group..4.The combination of serum NT-proBNP test and NIHISS score is more valuable in judging the condition and risk stratification of stroke. |
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