Frydland Martin, Kjaergaard Jesper, Erlinge David, Stammet Pascal, Nielsen Niklas, Wanscher Michael, Pellis Tommaso, Friberg Hans, Hovdenes Jan, Horn Janneke, Wetterslev Jørn, Thomsen Jakob H, Bro-Jeppesen John, Winther-Jensen Matilde, Wise Matthew P, Kuiper Michael, Cronberg Tobias, Gasche Yvan, Devaux Yvan, Åneman Anders, Hassager Christian
Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Am J Cardiol. 2016 Oct 1;118(7):998-1005. doi: 10.1016/j.amjcard.2016.07.006. Epub 2016 Jul 19.
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.
N 端前 B 型利钠肽（NT-proBNP）在心脏和大脑中表达，急性心脏和脑部疾病时血清水平会升高。我们旨在评估院外心脏骤停（OHCA）复苏后的昏迷患者血清水平与神经功能结局及死亡之间的可能关联。在目标温度管理（TTM）试验中，939 名纳入研究并随机分组至 33°C 或 36°C 进行 24 小时目标温度管理的 OHCA 昏迷患者中，700 名被纳入生物标志物子研究。其中，647 名（92%）在自主循环恢复（ROSC）后 24、48 和 72 小时测量了 NT-proBNP 的血清水平。6 个月时通过脑功能分类（CPC）评分和改良 Rankin 量表（mRS）评估神经功能结局。638 名患者（99%）的血清 NT-proBNP 水平≥125 pg/ml。ROSC 后 24 小时，33°C 进行目标温度管理的患者 NT-proBNP 血清水平（中位数 1472 pg/ml）显著低于 36°C 组（1914 pg/ml），p<0.01，但在 48 和 72 小时时无差异。在 24 小时时，NT-proBNP 四分位数增加与死亡相关（Plogrank<0.0001）。此外，校正潜在混杂因素后，血清 NT-proBNP 水平>中位数与不良神经功能结局独立相关（比值比，ORCPC 2.02，CI 1.34 至 3.05，p<0.001；ORmRS 2.28，CI 1.50 至 3.46，p<0.001）。ROSC 后 48 和 72 小时时这种关联减弱。总之，OHCA 昏迷患者血清 NT-proBNP 水平升高。此外，血清 NT-proBNP 水平受目标温度管理水平影响，并与死亡和不良神经功能结局相关。
