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

Frydland, Martin; Kjaergaard, Jesper; Erlinge, David LU ; Stammet, Pascal; Nielsen, Niklas LU ; Wanscher, Michael; Pellis, Tommaso; Friberg, Hans LU ; Hovdenes, Jan and Horn, Janneke, et al. (2016) In American Journal of Cardiology 118(7). p.998-1005
Abstract

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... (More)

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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American Journal of Cardiology
volume
118
issue
7
pages
8 pages
publisher
Excerpta Medica
external identifiers
  • scopus:84991736537
  • wos:000385332900010
ISSN
0002-9149
DOI
10.1016/j.amjcard.2016.07.006
language
English
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yes
id
208d4b6f-a3c2-4191-bda4-ffd89434040d
date added to LUP
2016-11-16 13:40:03
date last changed
2017-08-11 13:37:34
@article{208d4b6f-a3c2-4191-bda4-ffd89434040d,
  abstract     = {<p>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 &lt;0.01 but not at 48 and 72 hours. At 24 hours, an increase in NT-proBNP quartile was associated with death (P<sub>logrank</sub> &lt;0.0001). In addition, NT-proBNP serum levels &gt; median were independently associated with poor neurological outcome (odds ratio, OR<sub>CPC</sub> 2.02, CI 1.34 to 3.05, p &lt;0.001; OR<sub>mRS</sub> 2.28, CI 1.50 to 3.46, p &lt;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.</p>},
  author       = {Frydland, Martin and Kjaergaard, Jesper and Erlinge, David and Stammet, Pascal and Nielsen, Niklas and Wanscher, Michael and Pellis, Tommaso and Friberg, Hans and Hovdenes, Jan and Horn, Janneke and Wetterslev, Jørn and Thomsen, Jakob H. and Bro-Jeppesen, John and Winther-Jensen, Matilde and Wise, Matthew P. and Kuiper, Michael and Cronberg, Tobias and Gasche, Yvan and Devaux, Yvan and Åneman, Anders and Hassager, Christian},
  issn         = {0002-9149},
  language     = {eng},
  month        = {10},
  number       = {7},
  pages        = {998--1005},
  publisher    = {Excerpta Medica},
  series       = {American Journal of Cardiology},
  title        = {Usefulness of Serum B-Type Natriuretic Peptide Levels in Comatose Patients Resuscitated from Out-of-Hospital Cardiac Arrest to Predict Outcome},
  url          = {http://dx.doi.org/10.1016/j.amjcard.2016.07.006},
  volume       = {118},
  year         = {2016},
}