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

Martin Frydland; Jesper Kjaergaard; David Erlinge; Pascal Stammet; Niklas Nielsen; Michael Wanscher; Tommaso Pellis; Hans Friberg; Jan Hovdenes; Janneke Horn; Jørn Wetterslev; Jakob H. Thomsen; John Bro-Jeppesen; Matilde Winther-Jensen; Matthew P Wise; Michael Kuiper; Tobias Cronberg; Yvan Gasche; Yvan Devaux; Anders Åneman; Christian Hassager

doi:10.1016/j.amjcard.2016.07.006

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

Martin Frydland, Jesper Kjaergaard, David Erlinge, Pascal Stammet, Niklas Nielsen, Michael Wanscher, Tommaso Pellis, Hans Friberg, Jan Hovdenes, Janneke Horn, Jørn Wetterslev, Jakob H. Thomsen, John Bro-Jeppesen, Matilde Winther-Jensen, Matthew P Wise, Michael Kuiper, Tobias Cronberg, Yvan Gasche, Yvan Devaux, Anders ÅnemanChristian Hassager

8 Citationer (Scopus)

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 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 (P_logrank <0.0001). In addition, NT-proBNP serum levels > median were independently associated with poor neurological outcome (odds ratio, OR_CPC 2.02, CI 1.34 to 3.05, p <0.001; OR_mRS 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.

Originalsprog	Engelsk
Tidsskrift	American Journal of Cardiology
Vol/bind	118
Udgave nummer	7
Sider (fra-til)	998-1005
Antal sider	8
ISSN	0002-9149
DOI	https://doi.org/10.1016/j.amjcard.2016.07.006
Status	Udgivet - 1 okt. 2016

Adgang til dokumentet

10.1016/j.amjcard.2016.07.006

Citationsformater

Frydland, M., Kjaergaard, J., Erlinge, D., Stammet, P., Nielsen, N., Wanscher, M., Pellis, T., Friberg, H., Hovdenes, J., Horn, J., Wetterslev, J., Thomsen, J. H., Bro-Jeppesen, J., Winther-Jensen, M., Wise, M. P., Kuiper, M., Cronberg, T., Gasche, Y., Devaux, Y., ... Hassager, C. (2016). Usefulness of Serum B-Type Natriuretic Peptide Levels in Comatose Patients Resuscitated from Out-of-Hospital Cardiac Arrest to Predict Outcome. American Journal of Cardiology, 118(7), 998-1005. https://doi.org/10.1016/j.amjcard.2016.07.006

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 2016, 'Usefulness of Serum B-Type Natriuretic Peptide Levels in Comatose Patients Resuscitated from Out-of-Hospital Cardiac Arrest to Predict Outcome', American Journal of Cardiology, bind 118, nr. 7, s. 998-1005. https://doi.org/10.1016/j.amjcard.2016.07.006

@article{f5090a69fd0d4026bf1452891babb910,

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

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 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.",

keywords = "Journal Article",

author = "Martin Frydland and Jesper Kjaergaard and David Erlinge and Pascal Stammet and Niklas Nielsen and Michael Wanscher and Tommaso Pellis and Hans Friberg and Jan Hovdenes and Janneke Horn and J{\o}rn Wetterslev and Thomsen, {Jakob H.} and John Bro-Jeppesen and Matilde Winther-Jensen and Wise, {Matthew P} and Michael Kuiper and Tobias Cronberg and Yvan Gasche and Yvan Devaux and Anders {\AA}neman and Christian Hassager",

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doi = "10.1016/j.amjcard.2016.07.006",

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pages = "998--1005",

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T1 - Usefulness of Serum B-Type Natriuretic Peptide Levels in Comatose Patients Resuscitated from Out-of-Hospital Cardiac Arrest to Predict Outcome

AU - Frydland, Martin

AU - Kjaergaard, Jesper

AU - Erlinge, David

AU - Stammet, Pascal

AU - Nielsen, Niklas

AU - Wanscher, Michael

AU - Pellis, Tommaso

AU - Friberg, Hans

AU - Hovdenes, Jan

AU - Horn, Janneke

AU - Wetterslev, Jørn

AU - Thomsen, Jakob H.

AU - Bro-Jeppesen, John

AU - Winther-Jensen, Matilde

AU - Wise, Matthew P

AU - Kuiper, Michael

AU - Cronberg, Tobias

AU - Gasche, Yvan

AU - Devaux, Yvan

AU - Åneman, Anders

AU - Hassager, Christian

PY - 2016/10/1

Y1 - 2016/10/1

N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1016/j.amjcard.2016.07.006

DO - 10.1016/j.amjcard.2016.07.006

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C2 - 27614855

SN - 0002-9149

VL - 118

SP - 998

EP - 1005

JO - Am. J. Cardiol.

JF - Am. J. Cardiol.

IS - 7

ER -

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

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