Prognostic value of brain natriuretic peptide and N-terminal pro b-type natriuretic peptide in patients with cardiac arrest: A systematic review and meta-analysis

Abstract

Objective: The aim of the present study was to systematically review published evidence on the prognostic ability of brain natriuretic peptide (BNP) and N-terminal pro b-type natriuretic peptide (NT-proBNP) in patients with cardiac arrest.

Methodology: This review searched PubMed, Embase, Scopus, and Cochrane databases for studies assessing mortality, survival to discharge, return of spontaneous circulation (ROSC), or neurological outcomes in cardiac arrest patients based on BNP or NT-proBNP. Search limits were from database inception to 20th March 2025.

Results: Eleven studies were eligible. Meta-analysis showed a statistically significant association between high baseline BNP levels and mortality after cardiac arrest (OR: 2.47 95% CI: 1.24, 4.92 I2=90%). However, the results turned non-significant on exclusion of an outlier study (OR: 1.37 95% CI: 0.91, 2.07 I2=73%). Pooled analysis indicated that high baseline BNP levels were predictive of poor neurological outcomes (OR: 2.68 95% CI: 1.19, 6.04 I2=61%). This result was also not stable on sensitivity analysis. Association between BNP levels and ROSC and survival to discharge was conflicting. Pooled analysis also showed that NT-proBNP was not a significant predictor of mortality after cardiac arrest (OR: 1.16 95% CI: 0.95, 1.42 I2=76%), but descriptive analysis indicated that it could be a predictor of poor neurological outcomes.

Conclusions: Evidence on the prognostic ability of BNP and NT-proBNP for cardiac arrest is preliminary. BNP and NT-proBNP may potentially predict poor neurological outcomes after cardiac arrest. Limited and inconsistent evidence also shows that there may be no association between baseline level of these markers and mortality. Data on ROSC and survival to discharge is scarce and conflicting and needs more studies for robust conclusions. Given the high heterogeneity and lack of stability of outcomes on sensitivity analysis, the results must be interpreted with caution.