NT-proBNP in patients with out-of-hospital cardiac arrest: Results from the FINNRESUSCI Study

AimTo assess whether the established cardiovascular biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP) provides prognostic information in patients with out-of-hospital cardiac arrest due to ventricular tachycardia or fibrillation (OHCA-VT/VF).MethodsWe measured NT-proBNP levels in 155 patients with OHCA-VT/VF enrolled into a prospective multicenter observational study in 21 ICUs in Finland. Blood samples were drawn <6 h of OHCA-VT/VF and later after 24 h, 48 h, and 96 h. The end-points were mortality and neurological outcome classified according to Cerebral Performance Category (CPC) after one year. NT-proBNP levels were compared to high-sensitivity troponin T (hs-TnT) levels and established risk scores.ResultsNT-proBNP levels were higher in non-survivors compared to survivors on study inclusion (median 1003 [quartile (Q) 1-3 502-2457] vs. 527 [179-1284] ng/L, p = 0.001) and after 24 h (1913 [1012-4573] vs. 1080 [519-2210] ng/L, p < 0.001). NT-proBNP levels increased from baseline to 96 h after ICU admission (p < 0.001). NT-proBNP levels were significantly correlated to hs-TnT levels after 24 h (rho = 0.27, p = 0.001), but not to hs-TnT levels on study inclusion (rho = 0.05, p = 0.67). NT-proBNP levels at all time points were associated with clinical outcome, but only NT-proBNP levels after 24 h predicted mortality and poor neurological outcome, defined as CPC 3-5, in models that adjusted for SAPS II and SOFA scores. hs-TnT levels did not add prognostic information to NT-proBNP measurements alone.ConclusionNT-proBNP levels at 24 h improved risk assessment for poor outcome after one year on top of established risk indices, while hs-TnT measurements did not further add to risk prediction.