NT-proBNP and Neurologic Outcomes in Comatose Survivors of Out-of-Hospital Cardiac Arrest.

Abstract

Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an established biomarker associated with acute cardiovascular and cerebrovascular conditions, however its role in prognostication following OHCA is unclear and may be influenced by presenting rhythm. We sought to evaluate the association between NT-proBNP and neurologic outcomes in survivors of OHCA and to determine whether the association differed according to presenting rhythm.

Methods: This retrospective multicenter cohort study included comatose patients admitted to the ICU after OHCA (2/1/2017 to 1/31/2020) with an NT-proBNP measured within 24 hours of return of spontaneous circulation. The primary endpoint was poor neurologic outcome at hospital discharge defined as cerebral performance category (CPC) score 3-5.

Results: The study included 301 patients with median NT-proBNP of 1,108pg/mL (IQR 163-3,482). Multivariable adjusted logistic regression models revealed that NT-proBNP levels above the median were associated with increased risk of poor neurologic outcome (OR 2.50 [95%CI 1.03-6.20]; p=0.04) and increased risk of in-hospital mortality (2.30 [1.03-5.10]; p=0.04). When stratified by presenting rhythm, elevated NT-proBNP was associated with an increased risk of poor neurologic outcome (7.80 [2.20-27.60]; p = 0.002) and increased risk of mortality (5.90 [1.60-22.20]; p=0.009) among individuals with an initially shockable rhythm but no association among individuals with a non-shockable rhythm (p-interaction = 0.01 and 0.04 respectively).

Conclusion: NT-proBNP was independently associated with neurologic outcome and survival to hospital discharge in comatose survivors of OHCA admitted to the ICU. When stratified by presenting rhythm, NT-proBNP was only associated with outcomes among patients with a shockable rhythm.