Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Department of Otorhinolaryngology, Aarhus University Hospital, Aarhus, Denmark.
Ther Hypothermia Temp Manag. 2022 Jun;12(2):82-89. doi: 10.1089/ther.2021.0012. Epub 2021 Aug 10.
We aimed to evaluate the effect of prolonged targeted temperature management (TTM) in patients with out-of-hospital cardiac arrest (OHCA) on the levels of midregional pro-atrial natriuretic peptide (MR-proANP) and N-terminal pro b-type natriuretic peptide (NT-proBNP) and assess their potential as prognostic biomarkers. A preplanned analysis of "Targeted temperature management for 48 h vs 24 h and neurologic outcome after out-of-hospital cardiac arrest: A randomized clinical trial (TTH48 trial)," where patients were randomized to TTM at 33°C ± 1°C of standard duration (24 hours) versus prolonged (48 hours). Blood samples were drawn from patients with OHCA at two Scandinavian university hospitals at admission to the ICU and at 24, 48, and 72 hours after reaching the target temperature. Primary outcome was levels of MR-proANP and NT-proBNP. Secondary outcome was cerebral performance category (CPC 1-5) at 6 months. Samples from 114 patients were analyzed. Prolonged TTM significantly decreased the levels of MR-proANP and NT-proBNP at 48 hours compared with standard 24 hours-TTM ( < 0.01). However, there were no significant differences at other time points. Patients with poor outcome (CPC 3-5) had a statistically significantly increased MR-proANP level at 24 hours ( < 0.01) and 72 hours ( < 0.01) compared with the good outcome group (CPC 1-2). Prognostic performance was best at 24 hours for both MR-proANP and NT-proBNP; with an AUC of 0.73 (confidence interval [95% CI]: 0.63-0.83) and 0.72 (95 % CI: 0.59-0.85), respectively. Prolonged TTM lowered the levels of both MR-proANP and NT-proBNP at 48 hours. MR-proANP may add prognostic information in postcardiac arrest patients. ClinicalTrials.gov ID: NCT01689077.
我们旨在评估院外心脏骤停（OHCA）患者长时间目标温度管理（TTM）对中区域前心房利钠肽（MR-proANP）和 N 末端 pro-B 型利钠肽（NT-proBNP）水平的影响，并评估其作为预后生物标志物的潜力。这是一项针对“目标温度管理 48 小时与 24 小时对院外心脏骤停后神经功能结局的影响：一项随机临床试验（TTH48 试验）”的预先计划分析，该试验将患者随机分为 TTM 标准持续时间（24 小时）组和延长（48 小时）组。在两家斯堪的纳维亚大学医院，对接受 ICU 治疗的 OHCA 患者入院时、达到目标温度后 24、48 和 72 小时抽取血液样本。主要结局是 MR-proANP 和 NT-proBNP 水平。次要结局是 6 个月时的脑功能分类（CPC 1-5）。对 114 例患者的样本进行了分析。与标准 24 小时-TTM 相比，长时间 TTM 可显著降低 48 小时时的 MR-proANP 和 NT-proBNP 水平（<0.01）。然而，在其他时间点没有显著差异。预后不良（CPC 3-5）患者的 MR-proANP 水平在 24 小时（<0.01）和 72 小时（<0.01）均显著高于预后良好（CPC 1-2）组。MR-proANP 和 NT-proBNP 的预后性能在 24 小时时最佳，AUC 分别为 0.73（95%CI：0.63-0.83）和 0.72（95%CI：0.59-0.85）。长时间 TTM 可降低 48 小时时的 MR-proANP 和 NT-proBNP 水平。MR-proANP 可能会为心脏骤停后患者提供预后信息。ClinicalTrials.gov ID：NCT01689077。
