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

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 .

Intra‐arrest blood‐based biomarkers for out‐of‐hospital cardiac arrest: A scoping review

“…Most of the studies were conducted in Asia (63 studies, 53%). Only 22 studies (19%) had blood samples collected in the prehospital setting, and only six studies (5%) had intra‐arrest blood samples collected by paramedics in the prehospital setting 12–14,20,82,83 . Only three studies (3%) enrolled any pediatric patients 24,90,114 .…”

“…The search strategy identified a total of 11,834 records, of which 6914 were non‐duplicates. After applying all inclusion and exclusion criteria, 118 studies were included in the scoping review, as shown in Figure 1 11–128 …”

“…After applying all inclusion and exclusion criteria, 118 studies were included in the scoping review, as shown in Figure 1 . 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ,…”

Association of B-Type Natriuretic Peptide Level with Clinical Outcome in Out-of-Hospital Cardiac Arrest in Emergency Department Patients

“…In a previous prospective study, when 30-day mortality was the measured outcome, NT-pro BNP was high in non-survivors. However, it was confirmed that it was not a significant factor in multivariate analysis [29]. In another prior study, the NT-pro BNP levels of 155 OHCA shockable rhythm patients were measured after 24 h and provided improved risk assessment of poor outcomes after one year, on top of the established risk indices [30].…”

Activated factor XI-antithrombin complex presenting as an independent predictor of 30-days mortality in out-of-hospital cardiac arrest patients

“…In our study, we analysed activated Factor XI-antithrombin (FXIa-AT) complex, activated Factor IX-antithrombin (FIXa-AT) complex and TAT complex as a measure of coagulation activation. The primary aim of our study was to evaluate the independent prognostic utility of these three coagulation markers in a previously described population of OHCA patients with both shockable-and non-shockable heart rhythm [11]. As a second aim, this study was performed to improve our understanding of the pathophysiology related to coagulation activation during cardiac arrest, including both the intrinsic-and the extrinsic pathway.…”