Header

UZH-Logo

Maintenance Infos

Midregional proatrial natriuretic peptide improves risk stratification after ischemic stroke


De Marchis, Gian Marco; Schneider, Juliane; Weck, Anja; Fluri, Felix; Fladt, Joachim; Foerch, Christian; Mueller, Beat; Luft, Andreas; Christ-Crain, Mirjam; Arnold, Marcel; Katan, Mira (2018). Midregional proatrial natriuretic peptide improves risk stratification after ischemic stroke. Neurology, 90(6):e455-e465.

Abstract

OBJECTIVE To validate midregional proatrial natriuretic peptide (MR-proANP) for outcome prediction and diagnosis of cardioembolic stroke etiology compared to established clinical variables.
METHODS In this prospective multicenter cohort study, we quantified MR-proANP levels in ischemic stroke patients within 24 hours of onset. Primary outcome measures were 90-day mortality, unfavorable functional outcome (modified Rankin Scale score >2), and cardioembolic stroke etiology diagnosed during hospitalization.
RESULTS Of 788 included patients, 783 completed their 90-day follow-up, and 118 patients (15%) died. After full adjustment, MR-proANP levels were associated with 90-day mortality (adjusted hazard ratio 6.12, 95% confidence interval [CI] 2.36-15.84, = 0.01) and functional outcome (adjusted odds ratio [aOR] 2.46, 95% CI 1.05-5.74, = 0.038). For mortality prediction, adding MR-proANP to the regression model increased its discriminatory accuracy, and the continuous net reclassification index (cNRI) was 49% (95% CI 26%-78%, < 0.001). For functional outcome, there was no significant improvement in discrimination or reclassification. Cardioembolic stroke etiology and the diagnosis of atrial fibrillation at hospital discharge were associated with MR-proANP with an aOR of 2.10 (95% CI 1.11-3.97, = 0.02) and 18.35 (95% CI 7.94-42.45, < 0.001), respectively. The cNRI of MR-proANP for cardioembolic stroke etiology was not significant, as opposed to atrial fibrillation (78%, 95% CI 60%-89%, < 0.001). MR-proANP levels ≥289 pmol/L had a specificity of 86% and sensitivity of 48% for the diagnosis of atrial fibrillation.
CONCLUSION MR-proANP is a newly validated blood biomarker providing additional prognostic information for mortality after stroke. Higher MR-proANP levels were associated with cardioembolic stroke etiology and, even more strongly, atrial fibrillation.

Abstract

OBJECTIVE To validate midregional proatrial natriuretic peptide (MR-proANP) for outcome prediction and diagnosis of cardioembolic stroke etiology compared to established clinical variables.
METHODS In this prospective multicenter cohort study, we quantified MR-proANP levels in ischemic stroke patients within 24 hours of onset. Primary outcome measures were 90-day mortality, unfavorable functional outcome (modified Rankin Scale score >2), and cardioembolic stroke etiology diagnosed during hospitalization.
RESULTS Of 788 included patients, 783 completed their 90-day follow-up, and 118 patients (15%) died. After full adjustment, MR-proANP levels were associated with 90-day mortality (adjusted hazard ratio 6.12, 95% confidence interval [CI] 2.36-15.84, = 0.01) and functional outcome (adjusted odds ratio [aOR] 2.46, 95% CI 1.05-5.74, = 0.038). For mortality prediction, adding MR-proANP to the regression model increased its discriminatory accuracy, and the continuous net reclassification index (cNRI) was 49% (95% CI 26%-78%, < 0.001). For functional outcome, there was no significant improvement in discrimination or reclassification. Cardioembolic stroke etiology and the diagnosis of atrial fibrillation at hospital discharge were associated with MR-proANP with an aOR of 2.10 (95% CI 1.11-3.97, = 0.02) and 18.35 (95% CI 7.94-42.45, < 0.001), respectively. The cNRI of MR-proANP for cardioembolic stroke etiology was not significant, as opposed to atrial fibrillation (78%, 95% CI 60%-89%, < 0.001). MR-proANP levels ≥289 pmol/L had a specificity of 86% and sensitivity of 48% for the diagnosis of atrial fibrillation.
CONCLUSION MR-proANP is a newly validated blood biomarker providing additional prognostic information for mortality after stroke. Higher MR-proANP levels were associated with cardioembolic stroke etiology and, even more strongly, atrial fibrillation.

Statistics

Citations

Dimensions.ai Metrics
4 citations in Web of Science®
2 citations in Scopus®
Google Scholar™

Altmetrics

Downloads

0 downloads since deposited on 28 Dec 2018
34 downloads since 12 months

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:6 February 2018
Deposited On:28 Dec 2018 12:44
Last Modified:24 Sep 2019 23:58
Publisher:Lippincott Williams & Wilkins
ISSN:0028-3878
OA Status:Green
Publisher DOI:https://doi.org/10.1212/WNL.0000000000004922
PubMed ID:29321236

Download

Download PDF  'Midregional proatrial natriuretic peptide improves risk stratification after ischemic stroke'.
Preview
Content: Published Version
Filetype: PDF
Size: 560kB
View at publisher