Association between N-terminal pro-brain natriuretic peptide levels and outcomes of ischemic stroke: A systematic review and meta-analysis

PLoS One. 2025 Jun 27;20(6):e0322816. doi: 10.1371/journal.pone.0322816. eCollection 2025.

Abstract

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) was identified as an important biomarker of cardiovascular disease, in ischemic stroke. This study intends to assess the association of NT-proBNP levels with clinical outcomes of patients ischemic stroke patients.

Methods: A comprehensive search of MEDLINE, Web of Science, ScienceDirect, and Cochrane CENTRAL electronic databases was done for papers published till April 2024 and reporting on the levels of NT-proBNP in patients with ischemic stroke. Outcomes of interest included mortality (all-cause and cardiovascular) and neurological, and functional outcomes. A random-effects meta-analysis model was used, and final estimates were reported as pooled odds ratio (OR) with 95% confidence interval (CI).

Results: Elevated NT-proBNP levels were significantly linked to increased all-cause (pooled OR = 2.322, 95% CI: 1.718 to 2.925) and cardiovascular mortality (pooled OR = 1.797, 95% CI: 1.161 to 2.433). Higher NT-proBNP levels were also related to poorer functional outcomes (pooled OR = 1.129, 95% CI: 1.041 to 1.217). Patients with higher NT-proBNP levels had somewhat worse neurological outcomes (pooled OR = 1.317, 95% CI: 0.859 to 1.774). Considerable heterogeneity was detected across the studies (I² > 40% in most analyses).

Conclusion: NT-proBNP levels may serve as a robust predictor of mortality and offer potential utility in predicting functional recovery in ischemic stroke patients. The integration of NT-proBNP measurement into clinical settings may be beneficial for risk stratification and management of stroke survivors.

Publication types

  • Systematic Review
  • Meta-Analysis

MeSH terms

  • Biomarkers / blood
  • Humans
  • Ischemic Stroke* / blood
  • Ischemic Stroke* / mortality
  • Natriuretic Peptide, Brain* / blood
  • Peptide Fragments* / blood
  • Prognosis

Substances

  • Natriuretic Peptide, Brain
  • pro-brain natriuretic peptide (1-76)
  • Peptide Fragments
  • Biomarkers