NT-proBNP in patients with out-of-hospital cardiac arrest: Results from the FINNRESUSCI Study

• Published in: Resuscitation Vol. 104; pp. 12 - 18
• Main Authors: Myhre, Peder L, Tiainen, Marjaana, Pettilä, Ville, Vaahersalo, Jukka, Hagve, Tor-Arne, Kurola, Jouni, Varpula, Tero, Omland, Torbjørn, Røsjø, Helge
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.07.2016
• Subjects: Aged; Biomarker; Biomarkers - blood; Cardiac arrest; Emergency; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain - blood; NT-proBNP; Organ Dysfunction Scores; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - physiopathology; Peptide Fragments - blood; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Simplified Acute Physiology Score; Statistics, Nonparametric; Troponin T - blood; Ventricular fibrillation; Biomarker; NT-proBNP; Prognosis; Cardiac arrest; Ventricular fibrillation
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2016.04.007

Abstract Aim To assess whether the established cardiovascular biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP) provides prognostic information in patients with out-of-hospital cardiac arrest due to ventricular tachycardia or fibrillation (OHCA-VT/VF). Methods We measured NT-proBNP levels in 155 patients with OHCA-VT/VF enrolled into a prospective multicenter observational study in 21 ICUs in Finland. Blood samples were drawn <6 h of OHCA-VT/VF and later after 24 h, 48 h, and 96 h. The end-points were mortality and neurological outcome classified according to Cerebral Performance Category (CPC) after one year. NT-proBNP levels were compared to high-sensitivity troponin T (hs-TnT) levels and established risk scores. Results NT-proBNP levels were higher in non-survivors compared to survivors on study inclusion (median 1003 [quartile (Q) 1–3 502–2457] vs. 527 [179–1284] ng/L, p = 0.001) and after 24 h (1913 [1012–4573] vs. 1080 [519–2210] ng/L, p < 0.001). NT-proBNP levels increased from baseline to 96 h after ICU admission ( p < 0.001). NT-proBNP levels were significantly correlated to hs-TnT levels after 24 h (rho = 0.27, p = 0.001), but not to hs-TnT levels on study inclusion (rho = 0.05, p = 0.67). NT-proBNP levels at all time points were associated with clinical outcome, but only NT-proBNP levels after 24 h predicted mortality and poor neurological outcome, defined as CPC 3–5, in models that adjusted for SAPS II and SOFA scores. hs-TnT levels did not add prognostic information to NT-proBNP measurements alone. Conclusion NT-proBNP levels at 24 h improved risk assessment for poor outcome after one year on top of established risk indices, while hs-TnT measurements did not further add to risk prediction.