natriuretic-peptide--brain and Nervous-System-Diseases

This study aimed to investigate whether the serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin I levels at emergency department (ED) presentation predict long-term neurologic outcomes after acute charcoal-burning carbon monoxide (CO) poisoning.. This retrospective study included 220 patients suffering from charcoal-burning CO poisoning. The demographics, serum NT-proBNP and troponin I levels at ED presentation, treatment, clinical course during hospitalization, and long-term neurologic outcomes were collected.. The median serum NT-proBNP level at presentation was 48.8 (16.5-259) pg/mL, and 78 patients (35.5%) had elevated troponin I (>0.04 ng/mL) after acute charcoal-burning CO poisoning. The upper NT-proBNP and elevated troponin I groups had higher prevalences of respiratory failure, hypotension, and myocardial injury during hospitalization and altered mentality (GCS ≤14) at discharge than the lower NT-proBNP and normal troponin I groups. The incidence of persistent severe neurologic sequelae at 25 months after acute CO poisoning was 10.9%. The upper NT-proBNP and elevated troponin I groups had a higher incidence of poor long-term neurologic outcome than the counterpart groups. Log-transformed NT-proBNP and elevated troponin I were associated with poor long-term neurologic outcome in the univariate analysis, but only the adjusted log-transformed NT-proBNP remained an independent factor in the multivariate analysis. Compared with a predictive model including previously proposed predictors, the addition of log NT-proBNP improved the diagnostic accuracy for predicting poor long-term neurologic outcome. The serum NT-proBNP values for predicting poor long-term neurologic outcome were 74.6 and 32.7 pg/mL at fixed sensitivities of 95 and 99%, respectively.. Elevated serum NT-proBNP at ED presentation is correlated with a risk of poor long-term neurologic outcome after discharge in cases of acute charcoal-burning CO poisoning. NT-proBNP could significantly improve the risk stratification of patients who will experience poor long-term neurologic outcome after CO poisoning. This potentially valuable marker should be further validated.

Topics: Adult; Aged; Carbon Monoxide Poisoning; Charcoal; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Nervous System Diseases; Peptide Fragments; Prognosis; Retrospective Studies; Troponin I

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.

Topics: Adult; Aged; Biomarkers; Cardiopulmonary Resuscitation; Coma; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Nervous System Diseases; Odds Ratio; Out-of-Hospital Cardiac Arrest; Peptide Fragments; Prognosis; Randomized Controlled Trials as Topic

Two randomized studies have shown a neurological benefit of therapeutic hypothermia in comatose survivors after out-of-hospital cardiac arrest, but there are no studies of the cardiac neurohormone of B-type natriuretic peptide (BNP) in patients treated with hypothermia.. A prospective study was conducted of 109 comatose patients who were treated with mild hypothermia after out-of-hospital sudden cardiac arrest due to cardiac causes and whose BNP level was measured on arrival at the emergency room. The primary endpoint was a favorable neurological outcome at the time of hospital discharge. A total of 45 of the 109 patients had a favorable neurological outcome. The unadjusted rate of a favorable neurological outcome decreased in a stepwise fashion among patients in increasing quartiles of BNP level (p<0.001) and this association remained significant in subgroups of patients. The BNP cutoff value of 80 pg/ml for a favorable neurological outcome had an accuracy of 87.2%. In the multiple logistic-regression analysis, a BNP level of 80 pg/ml or less was an independent predictor of favorable neurological outcome.. The measurement of BNP was found to provide valuable information regarding the neurological outcome of comatose survivors treated with mild hypothermia after out-of-hospital cardiac arrest due to cardiac causes.

Topics: Aged; Coma; Female; Heart Arrest; Heart Diseases; Humans; Hypothermia, Induced; Male; Middle Aged; Natriuretic Peptide, Brain; Nervous System Diseases; Predictive Value of Tests; Prospective Studies; Resuscitation; Survivors; Treatment Outcome

In order to investigate whether C-type natriuretic peptide (CNP) is present in human cerebrospinal fluid (CSF), we measured CNP-like immunoreactivity (-LI) in human CSF by specific radioimmunoassay (RIA) for CNP. We also measured atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) concentrations in human CSF. ANP-LI, BNP-LI, and CNP-LI concentrations of CSF collected from fifteen patients without neurological disorders were 0.20 +/- 0.13, 0.27 +/- 0.10, and 2.13 +/- 0.27 fmol/ml (mean +/- S.D.), respectively. In fifteen patients with neurological disorders, ANP-LI, BNP-LI, and CNP-LI concentrations in CSF were 0.21 +/- 0.18, 0.33 +/- 0.19, and 2.09 +/- 0.82 fmol/ml, respectively. Although ANP-LI and BNP-LI concentrations in plasma were much higher than those in CSF, CNP-LI was undetectable in plasma (less than 0.2 fmol/ml). These results demonstrate that three natriuretic peptides are present in CSF and that CNP is the major natriuretic peptide in human CSF. These results suggest that CNP in CSF is originated from and play important roles in the central nervous system.

Topics: Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Chromatography, Gel; Female; Humans; Male; Middle Aged; Natriuresis; Natriuretic Peptide, Brain; Natriuretic Peptide, C-Type; Nerve Tissue Proteins; Nervous System Diseases; Radioimmunoassay