N-terminal pro-B-type natriuretic peptides' prognostic utility is overestimated in meta-analyses using studyspecific optimal diagnostic thresholds

Danielle Potgieter, Dale Simmers, Lisa Ryan, Bruce M. Biccard, Giovanna A. Lurati-Buse, Daniela M. Cardinale, Carol P W Chong, Miloslaw Cnotliwy, Sylvia I. Farzi, Radmilo J. Jankovic, Wen Kwang Lim, Elisabeth Mahla, Ramaswamy Manikandan, Anna Oscarsson, Michael P. Phy, Sriram Rajagopalan, William J. Van Gaal, Marek Waliszek, Reitze N. Rodseth

Research output: Contribution to journalArticlepeer-review

Abstract

Background: N-terminal fragment B-type natriuretic peptide (NT-proBNP) prognostic utility is commonly determined post hoc by identifying a single optimal discrimination threshold tailored to the individual study population. The authors aimed to determine how using these study-specific post hoc thresholds impacts meta-analysis results. Methods: The authors conducted a systematic review of studies reporting the ability of preoperative NT-proBNP measurements to predict the composite outcome of all-cause mortality and nonfatal myocardial infarction at 30 days after noncardiac surgery. Individual patient-level data NT-proBNP thresholds were determined using two different methodologies. First, a single combined NT-proBNP threshold was determined for the entire cohort of patients, and a meta-analysis conducted using this single threshold. Second, study-specific thresholds were determined for each individual study, with meta-analysis being conducted using these study-specific thresholds. Results: The authors obtained individual patient data from 14 studies (n = 2,196). Using a single NT-proBNP cohort threshold, the odds ratio (OR) associated with an increased NT-proBNP measurement was 3.43 (95% CI, 2.08 to 5.64). Using individual study-specific thresholds, the OR associated with an increased NT-proBNP measurement was 6.45 (95% CI, 3.98 to 10.46). In smaller studies (

Original languageEnglish
Pages (from-to)264-271
Number of pages8
JournalAnesthesiology
Volume123
Issue number2
Publication statusPublished - Aug 1 2015

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Medicine(all)

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