Midregional pro-atrial natriuretic peptide and outcome in patients with acute ischemic stroke.

Abstract

OBJECTIVES:

The purpose of this study was to examine the prognostic value of midregional pro-atrial natriuretic peptide (MR-proANP) in patients with acute ischemic stroke.

BACKGROUND:

The rapid and reliable estimation of prognosis in acute ischemic stroke is pivotal to optimize clinical care. MR-proANP, a recently described, stable fragment of the ANP precursor hormone, may be useful in this setting.

METHODS:

In a prospective observational study, we measured MR-proANP on admission in plasma of 362 consecutive patients presenting with acute ischemic stroke. The prognostic value of MR-proANP to predict mortality within 90 days and functional outcome (defined as a modified Rankin Scale of ≤2 or ≥3) was evaluated and compared with the National Institutes of Health Stroke Scale (NIHSS) score.

RESULTS:

The discriminatory accuracy, calculated with the area under the curve (AUC) of the receiver operating characteristics curve, of MR-proANP to predict death was comparable to the NIHSS (AUC: 0.86 [95% confidence interval (CI): 0.82 to 0.90] and 0.85 [95% CI: 0.81 to 0.89; p = 0.7]). Combined, the accuracy significantly improved (0.92 [95% CI: 0.88 to 0.96; p < 0.01]). The AUC of MR-proANP to predict functional outcome was 0.70 (95% CI: 0.65 to 0.75), similar to the NIHSS (0.75 [95% CI: 0.70 to 0.80]; p = 0.16). The prognostic value of MR-proANP for both outcomes was independent of the NIHSS. Higher MR-proANP concentrations were found in stroke of cardioembolic etiology.

CONCLUSIONS:

MR-proANP is a prognostic marker in the acute phase of stroke, improving the discriminatory value of the NIHSS, independently predicting post-stroke mortality and functional outcome. (The "COSMOS"-Study [Copeptin in Osmoregulation and Stress Assessment]; NCT00390962).

• Authors: Mira Katan, Felix Fluri, Philipp Schuetz, Nils G Morgenthaler, Christian Zweifel, Roland Bingisser, Ludwig Kappos, Andreas Steck, Stefan T Engelter, Beat Müller, Mirjam Christ-Crain
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 56 Issue 13 Pg. 1045-53 (Sep 21 2010) ISSN: 1558-3597 [Electronic] United States
• PMID: 20846604 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• midregional pro-atrial natriuretic peptide, human
• Atrial Natriuretic Factor

Topics

• Aged
• Aged, 80 and over
• Atrial Natriuretic Factor (blood)
• Biomarkers
• Brain Ischemia
• Female
• Humans
• Male
• Middle Aged
• Outcome Assessment, Health Care
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Stroke (blood)