Plasmatic B-type natriuretic peptide and C-reactive protein in hyperacute stroke as markers of CT-evidence of brain edema.

ABSTRACT

OBJECTIVE: Plasmatic B-type-natriuretic peptide (NT-PBNP) and C-reactive protein (CRP) have been reportedly elevated in stroke patients; however their clinical significance remains uncertain. The purpose of this work is to investigate whether elevation of these proteins at baseline predicts CT-evidence of brain edema. METHODS: We recruited 41 consecutive patients with stroke and determined NT-PBNP and CRP at baseline (within 5 hours after onset), after 48-72 hours, and at discharge. Stroke severity was measured by means of the NIHS scale at baseline and at discharge. We also carried out brain CT at admittance and after 48 hours. RESULTS: There were 29 ischemic strokes and 12 hemorrhagic strokes. Evidence of brain edema on delayed scan was seen in 14 patients. Baseline levels of NT-PBNP did not predict CT-evidence of edema but CRP levels did so significantly (0.7 mg/dl in patients without edema versus 4.7 mg in patients with edema; p=0.001). Both NT-PBNP and PC levels correlated poorly to NIHSS score and increased markedly from baseline to the second determination in patients with edema. For these patients the NT-PBNP increase was 133.6 pmol/l in comparison to 1.58 pmol/l in patients without edema (p=0.002). Neither CRP nor NT-PBNP baseline levels were predictive of dependency or death. CONCLUSIONS: We conclude that CRP at baseline but not NT-PBNP predicts CT evidence of brain edema in stroke patients. We hypothesize that NT-PBNP levels elevated in response to edema after 48 hours of admission.