N-Terminal Pro-brain Natriuretic Peptide Is Associated With Hemorrhagic Transformation and Poor Outcomes in Patients With Stroke Treated With Intravenous Thrombolysis

Figures

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  FIGURE 1. Flowchart of patient selection. Four hundred and four patients were finally included in the study after exclusion. Univariate analysis was performed regarding mortality, functional outcome, hemorrhagic transformation, and early neurologic deterioration as outcome. Multivariate analysis was performed regarding mortality, functional outcome, and hemorrhagic transformation as outcome. A clinical prediction model was then performed with 70% patients as training group and 30% as validation group, regarding functional outcome as the outcome.

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  FIGURE 2. N-terminal pro-brain natriuretic peptide (NT-proBNP) in poor functional outcome, mortality, hemorrhagic transformation, and early neurologic deterioration. One hundred seventy-seven patients had good functional outcomes and 227 had poor functional outcomes; 30 patients died, 374 survived; 72 patients had hemorrhagic transformation, 332 not; 31 patients had early neurological deterioration, 373 not. Distribution of NT-proBNP was depicted with natural log transformations, which was depicted with median and interquartile range. Patients with poor functional outcome, mortality, and hemorrhagic transformation had higher NT-proBNP levels compared with patients without. *P < 0.05.

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  FIGURE 3. Nomogram of individualized prediction model to predict 3-month poor functional outcome. The nomogram was composed of two areas, the upper area was designed to calculate the total score as the sum of scores for ln(NT-proBNP), National Institutes of Health Stroke Scale (NIHSS), and glucose. The lower area was designed to get the probability of patients to get a poor functional outcome.

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  FIGURE 4. Receiver operating characteristic (ROC) curve for individualized prediction model to predict 3-month poor functional outcome in training and validation group. In the training group, area under the curve (AUC) was 0.710. Cutoff point was marked on the figure with sensitivity 72.3%, specificity 60.8%, and cutoff value was 0.520. In the validation group, AUC was 0.764. Cutoff point was marked on the figure with sensitivity 80.3% and specificity 64.9% and cut off value was 0.416.

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  FIGURE 5. ROC curve for 10-fold cross-validation. The full ROC area was 0.727, and the test ROC area was 0.719 for 10-fold cross-validation.