E Hajdinjak1, P Klemen, S Grmec. 1. Centre for Emergency Medicine, Maribor, Slovenia; Faculty of Medicine, University of Maribor, Ulica talcev 9, 2000 Maribor, Slovenia. ehajdi@gmail.com.
Abstract
OBJECTIVE: Data regarding the value of prehospital measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin T as prognostic indicators of in-hospital mortality are limited. This prospective pilot study aimed to determine the value of a single combined measurement of NT-proBNP and troponin T for predicting in-hospital mortality in patients with acute ischaemic stroke in a prehospital emergency medicine centre. METHODS: Blood samples were collected in the prehospital setting and analysed for NT-proBNP and troponin T, using a portable device. Parameters previously associated with stroke severity (including prognostic scoring systems) were recorded and assessed as independent predictors of in-hospital mortality. RESULTS: In logistic regression analysis, elevated troponin T (odds ratio [OR] 1.8 [95% CI 1.1, 8.4) and elevated NT-proBNP (OR 5.80 [95% CI 1.3, 22.7]) were significantly associated with poor outcome in patients with acute ischaemic stroke. Combined measurement of troponin T plus NT-proBNP was most predictive of survival in stroke patients (93% sensitivity, 96% specificity, 80% negative predictive value, 98% positive predictive value and 92% area under the receiver operating curve). CONCLUSIONS: NT-proBNP and troponin T levels, measured during the prehospital phase of care after acute ischaemic stroke, are strong predictors of in-hospital mortality.
OBJECTIVE: Data regarding the value of prehospital measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin T as prognostic indicators of in-hospital mortality are limited. This prospective pilot study aimed to determine the value of a single combined measurement of NT-proBNP and troponin T for predicting in-hospital mortality in patients with acute ischaemic stroke in a prehospital emergency medicine centre. METHODS: Blood samples were collected in the prehospital setting and analysed for NT-proBNP and troponin T, using a portable device. Parameters previously associated with stroke severity (including prognostic scoring systems) were recorded and assessed as independent predictors of in-hospital mortality. RESULTS: In logistic regression analysis, elevated troponin T (odds ratio [OR] 1.8 [95% CI 1.1, 8.4) and elevated NT-proBNP (OR 5.80 [95% CI 1.3, 22.7]) were significantly associated with poor outcome in patients with acute ischaemic stroke. Combined measurement of troponin T plus NT-proBNP was most predictive of survival in strokepatients (93% sensitivity, 96% specificity, 80% negative predictive value, 98% positive predictive value and 92% area under the receiver operating curve). CONCLUSIONS:NT-proBNP and troponin T levels, measured during the prehospital phase of care after acute ischaemic stroke, are strong predictors of in-hospital mortality.