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.