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Serum neprilysin and the risk of death in patients with out-of-hospital cardiac arrest of non-traumatic origin

Zelniker, Thomas A. ; Spaich, Sebastian ; Stiepak, Jan ; Steger, Florian ; Katus, Hugo A. ; Preusch, Michael R.

In: European Heart Journal: Acute Cardiovascular Care, 9 (2020), Nr. S4. S169-S174. ISSN 2048-8726

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Background: Early risk stratification remains an unmet clinical need in patients with in out-of-hospital cardiac arrest. We hypothesised that soluble neprilysin may represent a promising biomarker in patients with out-of-hospital cardiac arrest of non-traumatic origin and provide new pathobiological insight.

Methods: This pilot study was a biomarker analysis from the Heidelberg Resuscitation Registry. Serum soluble neprilysin levels on admission were measured in 144 patients with successful return of spontaneous circulation after out-of-hospital cardiac arrest of non-traumatic origin. The primary endpoint was time to all-cause mortality. KM Event Rates are reported. Cox models were adjusted for age, bystander resuscitation, initial ECG rhythm, baseline estimated glomerular filtration rate, baseline lactate, left ventricular function at baseline, and targeted temperature management.

Results: In total, 90 (62.5%) patients died over a follow-up of at least 30 days. Soluble neprilysin correlated weakly with high-sensitivity troponin T (r=0.18, P=0.032) but did not correlate significantly with estimated glomerular filtration rate (r=−0.12) or lactate (r=0.11). Patients with elevated soluble neprilysin levels on admission were at significantly higher risk of all-cause mortality (Q4 69.1% vs. Q1 48.4%). After multivariable adjustment, soluble neprilysin in the top quartile (Q4) was significantly associated with all-cause mortality (Q4 vs. Q1: adjusted hazard ratio 2.48 (1.20–5.12)). In an adjusted multimarker model including high-sensitivity troponin T and high-sensitivity C-reactive protein, soluble neprilysin and high-sensitivity troponin T remained independently associated with all-cause mortality (soluble neprilysin: adjusted hazard ratio 2.27 (1.08–4.78); high-sensitivity troponin T: adjusted hazard ratio 3.40 (1.63–7.09)).

Conclusion: Soluble neprilysin, measured as early as on hospital admission, was independently associated with allcause mortality in patients with out-of-hospital cardiac arrest of non-traumatic origin and may prove to be useful in the estimation of risk in these patients.

Item Type: Article
Journal or Publication Title: European Heart Journal: Acute Cardiovascular Care
Volume: 9
Number: S4
Publisher: Sage Publ.
Place of Publication: London
Edition: Zweitveröffentlichung
Date Deposited: 12 Jan 2021 13:57
Date: 2020
ISSN: 2048-8726
Page Range: S169-S174
Faculties / Institutes: Medizinische Fakultät Heidelberg > Medizinische Universitäts-Klinik und Poliklinik
Subjects: 610 Medical sciences Medicine
Uncontrolled Keywords: out-of-hospital cardiac arrest, biomarker, neprilysin
Additional Information: Dieser Beitrag ist aufgrund einer (DFG-geförderten) Allianz bzw. Nationallizenz frei zugänglich. *** This publication is freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively.
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