Usefulness of Serum B-Type Natriuretic Peptide Levels in Comatose Patients Resuscitated from Out-of-Hospital Cardiac Arrest to Predict Outcome.

Frydland M; Kjaergaard J; Erlinge D; Stammet P; Nielsen N; Wanscher M; Pellis T; Friberg H; Hovdenes J; Horn J; Wetterslev J; Thomsen JH; Bro-Jeppesen J; Winther-Jensen M; Wise MP; Kuiper M; Cronberg T; Gasche Y; Devaux Y; Åneman A; Hassager C

doi:10.1016/j.amjcard.2016.07.006

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Journal article

Usefulness of Serum B-Type Natriuretic Peptide Levels in Comatose Patients Resuscitated from Out-of-Hospital Cardiac Arrest to Predict Outcome.

Frydland M Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: martin.frydland@me.com.
Kjaergaard J Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Erlinge D Department of Cardiology, Skåne University Hospital, Lund, Sweden.
Stammet P Department of Anaesthesia and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg.
Nielsen N Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
Wanscher M Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Pellis T Department of Intensive Care, Santa Maria degli Angeli, Pordenone, Italy.
Friberg H Department of Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden.
Hovdenes J Department of Anaesthesia and Intensive Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Horn J Department of Intensive Care, Academic Medical Centrum, Amsterdam, The Netherlands.
Wetterslev J Copenhagen Trial Unit, Centre of Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark.
Thomsen JH Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Bro-Jeppesen J Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Winther-Jensen M Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Wise MP Department of Intensive Care, University Hospital of Wales, Cardiff, United Kingdom.
Kuiper M Department of Intensive Care, Leeuwarden Medical Centrum, Leeuwarden, The Netherlands.
Cronberg T Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden.
Gasche Y Department of Intensive Care, Geneva University Hospital, Geneva, Switzerland.
Devaux Y Laboratory of Cardiovascular Research, Luxembourg Institute of Health, Luxembourg.
Åneman A Intensive Care Unit, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, The Ingham Institute for Applied Medical Research, Sydney, Australia.
Hassager C Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.

2016-09-12

Published in:

The American journal of cardiology. - 2016

Out-of-Hospital Cardiac Arrest

Randomized Controlled Trials as Topic

English 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.

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