Dutta Abhishek, Alirhayim Zaid, Masmoudi Youssef, Azizian John, McDonald Lawson, Jogu Hanumantha R, Qureshi Waqas T, Majeed Nasir
571678Memorial Sloan Kettering Cancer Center, New York, NY, USA.
144889King Fahad Specialist Hospital, Dammam, Saudi Arabia.
J Intensive Care Med. 2022 Jun;37(6):803-809. doi: 10.1177/08850666211034728. Epub 2021 Aug 30.
Neurological prognosis after cardiac arrest remains ill-defined. Plasma brain natriuretic peptide (BNP) may relate to poor neurological prognosis in brain-injury patients, though it has not been well studied in survivors of cardiac arrest.
We performed a retrospective review and examined the association of BNP with mortality and neurological outcomes at discharge in a cohort of cardiac arrest survivors enrolled from January 2012 to December 2016 at the Wake Forest Baptist Hospital, in North Carolina. Cerebral performance category (CPC) and modified Rankin scales were calculated from the chart based on neurological evaluation performed at the time of discharge. The cohort was subdivided into quartiles based on their BNP levels after which multivariable adjusted logistic regression models were applied to assess for an association between BNP and poor neurological outcomes as defined by a CPC of 3 to 4 and a modified Rankin scale of 4 to 5.
Of the 657 patients included in the study, 254 patients survived until discharge. Among these, poor neurological status was observed in 101 (39.8%) patients that had a CPC score of 3 to 4 and 97 patients (38.2%) that had a modified Rankin scale of 4 to 5. Mean BNP levels were higher in patients with poor neurological status compared to those with good neurological status at discharge ( = .03 for CPC 3-4 and = .02 for modified Rankin score 4-5). BNP levels however, did not vary significantly between patients that survived and those that expired ( = .22). BNP did emerge as a significant discriminator between patients with severe neurological disability at discharge when compared to those without. The area under the curve for BNP predicting a modified Rankin score of 4 to 5 was 0.800 (95% confidence interval [CI] 0.756-0.844, < .001) and for predicting CPC 3 to 4 was 0.797 (95% CI 0.756-0.838, < .001). BNP was able to significantly improve the net reclassification index and integrated discriminatory increment ( < .05). BNP was not associated with long-term all-cause mortality ( > .05).
In survivors of either inpatient or out-of-hospital cardiac arrest, increased BNP levels measured at the time of arrest predicted severe neurological disability at discharge. We did not observe an independent association between BNP levels and long-term all-cause mortality. BNP may be a useful biomarker for predicting adverse neurological outcomes in survivors of cardiac arrest.
心脏骤停后的神经学预后仍不明确。血浆脑钠肽（BNP）可能与脑损伤患者不良神经学预后相关，不过在心脏骤停幸存者中尚未得到充分研究。
我们进行了一项回顾性研究，在北卡罗来纳州维克森林浸礼会医院2012年1月至2016年12月纳入的一组心脏骤停幸存者队列中，研究BNP与出院时死亡率及神经学结局的关联。根据出院时进行的神经学评估，从病历中计算出脑功能分类（CPC）和改良Rankin量表评分。根据BNP水平将该队列分为四分位数，之后应用多变量校正逻辑回归模型，评估BNP与CPC为3至4且改良Rankin量表评分为4至5所定义的不良神经学结局之间的关联。
该研究纳入的657例患者中，254例存活至出院。其中，101例（39.8%）患者CPC评分为3至4，97例（38.2%）患者改良Rankin量表评分为4至5，观察到神经学状态不佳。出院时神经学状态不佳的患者平均BNP水平高于神经学状态良好的患者（CPC为3 - 4时P = 0.03，改良Rankin评分为4 - 5时P = 0.02）。然而，存活患者与死亡患者之间的BNP水平无显著差异（P = 0.22）。与无严重神经功能障碍的患者相比，BNP确实成为出院时严重神经功能障碍患者的显著鉴别指标。BNP预测改良Rankin评分为4至5的曲线下面积为0.800（95%置信区间[CI] 0.756 - 0.844，P < 0.001），预测CPC为3至4的曲线下面积为0.797（95% CI 0.756 - 0.838，P < 0.001）。BNP能够显著改善净重新分类指数和综合鉴别增量（P < 0.05）。BNP与长期全因死亡率无关（P > 0.05）。
在住院或院外心脏骤停的幸存者中，心脏骤停时测得的BNP水平升高预示出院时存在严重神经功能障碍。我们未观察到BNP水平与长期全因死亡率之间存在独立关联。BNP可能是预测心脏骤停幸存者不良神经学结局的有用生物标志物。
