Emergency-transport N-terminal pro-B-type natriuretic peptide, renal function, and discharge outcome after acute...

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is often elevated in acute stroke, but reduced estimated glomerular filtration rate (eGFR) can complicate interpretation. We examined its association with poor discharge outcome after adjustment for registry variables.

We retrospectively studied 256 emergency-transported patients with ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. The primary outcome was discharge modified Rankin Scale (mRS) 3-6. Logistic regression estimated odds ratios (ORs) per doubling of NT-proBNP, adjusted for age, sex, eGFR, and hemorrhagic stroke. Renal-function and subtype analyses were exploratory.

The primary cohort included 212 patients; 137 (64.6%) had mRS 3-6. NT-proBNP, but not eGFR, was higher with poor outcome. The adjusted OR was 1.29 (95% confidence interval [CI] 1.12-1.50; P = 0.001). Renal-stratum ORs were 1.18 (95% CI 0.98-1.42) for eGFR ≥ 60 and 1.42 (95% CI 1.11-1.81) for eGFR < 60 mL/min/1.73 m² (interaction P = 0.196). Exploratory subtype-specific ORs were 1.39 (95% CI 1.17-1.66) in ischemic stroke and 0.97 (95% CI 0.74-1.28) in intracerebral hemorrhage. The hemorrhagic-versus-ischemic interaction was not significant (P = 0.204).

Early NT-proBNP was associated with poor discharge outcome after registry adjustment, without establishing independence from unmeasured confounding. Limited subgroup sizes prevented exclusion of effect modification. Predictive performance was not evaluated; the findings do not support routine clinical risk-stratification use.