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Observational Study
. 2020 Aug 24;20(1):382.
doi: 10.1186/s12872-020-01630-x.

N-terminal pro-B-type natriuretic peptide as a prognostic indicator for 30-day mortality following out-of-hospital cardiac arrest: a prospective observational study

Reidun Aarsetøy  1   2 , Torbjørn Omland  3   4 , Helge Røsjø  5 , Heidi Strand  6 , Thomas Lindner  7 , Hildegunn Aarsetøy  8 , Harry Staines  9 , Dennis W T Nilsen  10   11
Affiliations
Observational Study

N-terminal pro-B-type natriuretic peptide as a prognostic indicator for 30-day mortality following out-of-hospital cardiac arrest: a prospective observational study

Reidun Aarsetøy et al. BMC Cardiovasc Disord. .

Abstract

Background: Early risk stratification applying cardiac biomarkers may prove useful in sudden cardiac arrest patients. We investigated the prognostic utility of early-on levels of high sensitivity cardiac troponin-T (hs-cTnT), copeptin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with out-of-hospital cardiac arrest (OHCA).

Methods: We conducted a prospective observational unicenter study, including patients with OHCA of assumed cardiac origin from the southwestern part of Norway from 2007 until 2010. Blood samples for later measurements were drawn during cardiopulmonary resuscitation or at hospital admission.

Results: A total of 114 patients were included, 37 patients with asystole and 77 patients with VF as first recorded heart rhythm. Forty-four patients (38.6%) survived 30-day follow-up. Neither hs-cTnT (p = 0.49), nor copeptin (p = 0.39) differed between non-survivors and survivors, whereas NT-proBNP was higher in non-survivors (p < 0.001) and significantly associated with 30-days all-cause mortality in univariate analysis, with a hazard ratio (HR) for patients in the highest compared to the lowest quartile of 4.6 (95% confidence interval (CI), 2.1-10.1), p < 0.001. This association was no longer significant in multivariable analysis applying continuous values, [HR 0.96, (95% CI, 0.64-1.43), p = 0.84]. Similar results were obtained by dividing the population by survival at hospital admission, excluding non-return of spontaneous circulation (ROSC) patients on scene [HR 0.93 (95% CI, 0.50-1.73), P = 0.83]. We also noted that NT-proBNP was significantly higher in asystole- as compared to VF-patients, p < 0.001.

Conclusions: Early-on levels of hs-cTnT, copeptin and NT-proBNP did not provide independent prognostic information following OHCA. Prediction was unaffected by excluding on-scene non-ROSC patients in the multivariable analysis.

Trial registration: ClinicalTrials. gov, NCT02886273 .

Keywords: Copeptin; High-sensitivity cardiac troponin T; N-terminal pro-B-type natriuretic peptide; Out-of-hospital cardiac arrest; Prognosis.

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Conflict of interest statement

T.O. and H.R. are partners in a patent application filed by the University of Oslo regarding the use of secretoneurin as a biomarker in cardiovascular disease and in patients with critical illness. H. R and T.O. have financial interests in CardiNor AS, which holds the license to commercialize secretoneurin. T.O. and H.R. have also received personal payments from CardiNor AS. H. R have also received personal fees from Novartis and Thermo Fisher BRAHMS. T. O has received honoraria and research support from Roche Diagnostics via Akershus University Hospital.

Figures

Fig. 1
Fig. 1
Flow chart displaying selection and classification of patients with out-of-hospital cardiac arrest recruited between February 2007 and November 2010
Fig. 2
Fig. 2
Survival curves up to 30-days in OHCA-patients stratified by NT-proBNP quartiles
Fig. 3
Fig. 3
Adjusted hazard ratio and 95% confidence intervals for 30-day all-cause mortality according to selected risk factors from two different multivariable models. a Model 1, b Model 2. Hazard ratio (squares), 95% confidence interval (lines). Abbreviations: OHCA, out-of-hospital cardiac arrest; CPR, cardiopulmonary resuscitation; 95% CI, 95% confidence interval
See this image and copyright information in PMC

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