| Background and objective:Acute ischemic stroke(AIS)led to a huge social and economic burden worldwide.Intravenous thrombolysis(IVT)was a crucial therapy,however,around half of the patients failed to benefit from it.Because IVT had the risk of hemorrhagic transformation and disease deterioration,it is particularly important to screen patients reasonably and make thrombolytic decisions carefully,to reduce the risk of hemorrhagic transformation.Up to now,many studies explored the relationship between hemorrhagic transformation with radiological or serum biomarkers,tried to predict the prognosis of patients who underwent thrombolysis and assist in making the treatment decisions.However,most biomarkers were collected after thrombolysis.Whether these biomarkers pre-thrombolysis related to prognosis or the risk of hemorrhagic transformation was still unknown.The author found that N-terminal pro-B-type natriuretic peptide(NT-proBNP)was associated with hemorrhagic transformation in previous study.This study was designed to further explore the relationship between pre-thrombolysis NT-proBNP and hemorrhagic transformation.Material and Methods:From August 2021 to September 2022,patients with AIS underwent IVT were continuously enrolled in our hospital.NT-proBNP was collected before IVT,and medical history,vital signs,clinical symptoms,and head CT examination were also evaluated and collected.Standardized treatment was administrated during hospitalization,the changes of the conditions and clinical data were recorded in detail.3-months follow-up was conducted to evaluate the functional outcome and adverse events.Hemorrhagic transformation,Early neurological deterioration,3 month functional outcome and death were determined as the outcome.Univariate and multivariate binary logistic regression were performed to determine the association between NT-proBNP and hemorrhagic transformation.The receiver operation characteristic curve(ROC)curve was drafted to assess the predictive value of NT-proBNP in hemorrhagic transformation,sensitivity,specificity,area under curve(AUC)and cut-off point were also calculated.P value<0.05 was statistically significant.SPSS software version 21.0 was used for statistical analysis.Results:A total of 242 patients with AIS who received IVT were included in this study.Pre-thrombolysis was associated with the hemorrhagic transformation(OR 1.53,95%CI 1.23-1.91),while,it was not associated with early neurological deterioration(OR 1.22,95% CI 0.90-1.64),3-month functional outcome(OR 1.09,95% CI0.92-1.30),and death within 3 months(OR 1.20,95% CI 0.86-1.68).After adjustment by multivariate binary logistic regression,NT-proBNP(OR 1.55,95% CI 1.17-2.05),bridging therapy(OR 6.90,95% CI 2.42-19.67),and large atherosclerotic stroke(OR2.40,95% CI 1.10-5.23)were independent predictors of post-thrombolysis hemorrhage transformation.Pre-thrombolysis NT-proBNP had the highest predictive value for hemorrhagic transformation(AUC 0.699,95% CI 0.614-0.784),bridging therapy(AUC 0.599,95% CI 0.499-0.698)and large atherosclerotic stroke(AUC0.600,95% CI 0.495-0.705)followed.When Ln(NT-proBNP)=3.85 was used as the cut-off value,the sensitivity and specificity of NT-proBNP to predict hemorrhagic transformation after thrombolysis were 81.3% and 30.5% respectively.Conclusions:Pre-thrombolysis NT-proBNP was independently associated with hemorrhagic transformation after thrombolysis.NT-proBNP before thrombolysis was of great value in assessing bleeding risk and assisting thrombolysis decision-making before intravenous thrombolysis. |
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