PURPOSE: Our study aimed to evaluate the prognostic value of NT-proBNP in predicting adverse outcomes among patients with anterior circulation infarction (ACI) and posterior circulation infarction (PCI), specifically in those without pre-existing cardiac comorbidities. PATIENTS AND METHODS: This single-center, prospective observational study enrolled patients with acute ischemic stroke (AIS) within 7 days of symptom onset. We aimed to elucidate predictive role of NT-proBNP levels in determining adverse outcomes in AIS patients. Additionally, the study sought to explore the relationship between NT-proBNP levels and the risk of poor functional outcomes in both ACI and PCI patients without underlying cardiac comorbidities. RESULTS: A total of 821 patients were included in our study. Both univariate and multivariate logistic analyses indicated that higher NT-proBNP was an independent risk factor for adverse outcomes of ischemic stroke patients at 90 days. In noncardiogenic patients, the risks of adverse outcomes during follow-up were significantly elevated in the medium and high NT-proBNP groups (medium group: OR 1.75, 95% CI 1.03-2.98, P=0.039
high group: OR 2.46, 95% CI 1.30-4.67, P=0.006), with a dose-dependent trend. The association was similarly observed in patients with isolated ACI (medium group: OR 2.02, 95% CI 1.06-3.83, P=0.031
high group: OR 2.70, 95% CI 1.25-5.79, P=0.011). High NT-proBNP levels were independently associated with END in patients without underlying cardiac comorbidities (high group: OR 2.14, 95% CI 1.06-4.31, P=0.033) and this association was also observed in ACI patients (high group: OR 5.39, 95% CI 1.70-17.04, P=0.004). Moreover, when incorporated into the clinical prediction model, NT-proBNP exhibited excellent sensitivity and specificity for predicting stroke-related functional outcomes. CONCLUSION: NT-proBNP demonstrates potential as a valuable biomarker in the clinical predictive model for functional outcomes specifically in ACI patients suggesting that elevated NT-proBNP levels in these patients should prompt closer monitoring and more comprehensive patient management. TRIAL REGISTRATION: https://www.chictr.org.cn/, ChiCTR2300067696.