Usefulness of Serum B-Type Natriuretic Peptide Levels in Comatose Patients Resuscitated from Out-of-Hospital Cardiac Arrest to Predict Outcome.
N-terminal pro-B-type natriuretic (NT-proBNP) is expressed in the heart and brain, and serum levels are elevated in acute heart and brain diseases. We aimed to assess the possible association between serum levels and neurological outcome and death in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA). Of the 939 comatose OHCA patients enrolled and randomized in the Targeted Temperature Management (TTM) trial to TTM at 33°C or 36°C for 24 hours, 700 were included in the biomarker substudy. Of these, 647 (92%) had serum levels of NT-proBNP measured 24, 48, and 72 hours after return of spontaneous circulation (ROSC). Neurological outcome was evaluated by the Cerebral Performance Category (CPC) score and modified Rankin Scale (mRS) at 6 months. Six hundred thirty-eight patients (99%) had serum NT-proBNP levels ≥125 pg/ml. Patients with TTM at 33°C had significantly lower NT-proBNP serum levels (median 1,472 pg/ml) than those in the 36°C group (1,914 pg/ml) at 24 hours after ROSC, p <0.01 but not at 48 and 72 hours. At 24 hours, an increase in NT-proBNP quartile was associated with death (Plogrank <0.0001). In addition, NT-proBNP serum levels > median were independently associated with poor neurological outcome (odds ratio, ORCPC 2.02, CI 1.34 to 3.05, p <0.001; ORmRS 2.28, CI 1.50 to 3.46, p <0.001) adjusted for potential confounders. The association was diminished at 48 and 72 hours after ROSC. In conclusion, NT-proBNP serum levels are increased in comatose OHCA patients. Furthermore, serum NT-proBNP levels are affected by level of TTM and are associated with death and poor neurological outcome.
Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: martin.frydland@me.com.
Martin
M
Frydland
Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Jesper
J
Kjaergaard
Department of Cardiology, Skåne University Hospital, Lund, Sweden.
David
D
Erlinge
Department of Anaesthesia and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg.
Pascal
P
Stammet
Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
Niklas
N
Nielsen
Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Michael
M
Wanscher
Department of Intensive Care, Santa Maria degli Angeli, Pordenone, Italy.
Tommaso
T
Pellis
Department of Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden.
Hans
H
Friberg
Department of Anaesthesia and Intensive Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Jan
J
Hovdenes
Department of Intensive Care, Academic Medical Centrum, Amsterdam, The Netherlands.
Janneke
J
Horn
Copenhagen Trial Unit, Centre of Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark.
Jørn
J
Wetterslev
Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Jakob H
JH
Thomsen
Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
John
J
Bro-Jeppesen
Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Matilde
M
Winther-Jensen
Department of Intensive Care, University Hospital of Wales, Cardiff, United Kingdom.
Matthew P
MP
Wise
Department of Intensive Care, Leeuwarden Medical Centrum, Leeuwarden, The Netherlands.
Michael
M
Kuiper
Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden.
Tobias
T
Cronberg
Department of Intensive Care, Geneva University Hospital, Geneva, Switzerland.
Yvan
Y
Gasche
Laboratory of Cardiovascular Research, Luxembourg Institute of Health, Luxembourg.
Yvan
Y
Devaux
Intensive Care Unit, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, The Ingham Institute for Applied Medical Research, Sydney, Australia.
Anders
A
Åneman
Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Christian
C
Hassager
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016887:Cardiopulmonary Resuscitation; D003128:Coma / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009422:Nervous System Diseases / Q000097:blood* / Q000209:etiology; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000628:therapy; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain