Predictive Value Of Amino-terminal B-type Natriuretic Peptide Precursor For Hemorrhagic Transformation In Patients With Acute Ischemic Stroke

Background Hemorrhagic transformation is a common complication of acute ischemic stroke.It aggravates the patients' condition and brings serious contradictions to the treatment.Existing studies suggest that some biochemical indicators and imaging findings of patients are risk factors of hemorrhagic transformation,and can predict the occurrence of hemorrhagic transformation as well.Existing studies show that the level of amino-terminal B-type natriuretic peptide precursor is closely related to the occurrence of ischemic stroke,but there are few reports on whether the level of amino-terminal B-type natriuretic peptide precursor is related to the risk of hemorrhagic transformation in patients with acute ischemic stroke.Objective To clarify the risk and protective factors of hemorrhagic transformation in patients with acute ischemic stroke who have notreceived intravenous thrombolysis and endovascular treatment,and to clarify the correlation between the level of amino terminal B-type natriuretic peptide precursor and hemorrhagic transformation,to determine whether it has predictive value for hemorrhagic transformation,and to assist clinicians in identifying high-risk patients with hemorrhagic transformation.Method Collected the patients with acute ischemic stroke who were not treated by intravenous thrombolysis or endovascular treatment in the First Affiliated Hospital of Chongqing Medical University.The patients were divided into hemorrhagic transformation group and non-hemorrhagic transformation group.General information of patients was collected at admission,and biochemical indicators such as amino-terminal B-type brain natriuretic peptide precursor level were completed within 24 hours of admission.After admission,we complete the imaging examinations of MRI and CTA to clarify the clinical data of patients' lesions,vascular condition and TOAST classification.The risk and protective factors of HT were identified and the predictive value of NT-proBNP to HT was evaluated through data analysis among groups.Result 1.A total of 214 patients with acute ischemic stroke were included in the study,39 in HT group(18.2%)and 175 in non-HT group(81.8%).2.The differences on massive cerebral infarction(22,56.4%),NIHSS score(13,7-17),uric acid level(340.90±124.14)?mol/L,small-vessel occlusion subtypes infarction(1,2.6%) in HT group and massive cerebral infarction(6,3.4%),NIHSS score(3,1-5),uric acid level(325.60±92.64)?mol/L and small-vessel occlusion subtypes infarction(72,41.1%) in non-HT group(6,3.4%) are statistically significant(P<0.05),massive cerebral infarction(OR=16.497,P 0.000),NIHSS score(OR=1.569,P0.044)were independent risk factors for HT,and uric acid level(OR=0.580,P 0.016) and small-vessel occlusion subtypes infarction(OR=0.103,P0.048) were protective factors for HT.3.NT-proBNP level(868,361-3098)pg/ml in HT group was higher than that in non-HT group(131,65-415)pg/ml,and the difference was statistically significant(P 0.02).The area under ROC curve of NT-proBNP for prediction of HT is 0.805,and the optimum predictive value is 422.5pg/ml.The sensitivity and specificity of NT-proBNP are 71.8% and 77.7% respectively.Conclusion 1.Massive cerebral infarction and NIHSS score were independent risk factors of HT.2.Uric acid level and small-vessel occlusion subtypes cerebral infarction are protective factors of HT.3.NT-proBNP level is related to the occurrence of HT,which has acertain predictive value for the occurrence of HT.