The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: A systematic review and individual patient data meta-analysis

Reitze N. Rodseth, Bruce M. Biccard, Yannick Le Manach, Daniel I. Sessler, Giovana A. Lurati Buse, Lehana Thabane, Robert C. Schutt, Daniel Bolliger, Lucio Cagini, Daniela Cardinale, Carol P W Chong, Rong Chu, Miłosław Cnotliwy, Salvatore Di Somma, René Fahrner, Wen Kwang Lim, Elisabeth Mahla, Ramaswamy Manikandan, Francesco Puma, Wook B. PyunMilan Radović, Sriram Rajagopalan, Stuart Suttie, Thuvaraha Vanniyasingam, William J. Van Gaal, Marek Waliszek, P. J. Devereaux

Research output: Contribution to journalArticle

Abstract

Objectives The objective of this study was to determine whether measuring post-operative B-type natriuretic peptides (NPs) (i.e., B-type natriuretic peptide [BNP] and N-terminal fragment of proBNP [NT-proBNP]) enhances risk stratification in adult patients undergoing noncardiac surgery, in whom a pre-operative NP has been measured. Background Pre-operative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated post-operative NP concentrations are independently associated with these complications. It is not clear whether there is value in measuring post-operative NP when a pre-operative measurement has been done. Methods We conducted a systematic review and individual patient data meta-analysis to determine whether the addition of post-operative NP levels enhanced the prediction of the composite of death and nonfatal myocardial infarction at 30 and ≥180 days after surgery. Results Eighteen eligible studies provided individual patient data (n = 2,179). Adding post-operative NP to a risk prediction model containing pre-operative NP improved model fit and risk classification at both 30 days (corrected quasi-likelihood under the independence model criterion: 1,280 to 1,204; net reclassification index: 20%; p <0.001) and ≥180 days (corrected quasi-likelihood under the independence model criterion: 1,320 to 1,300; net reclassification index: 11%; p = 0.003). Elevated post-operative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio: 3.7; 95% confidence interval: 2.2 to 6.2; p <0.001) and ≥180 days (odds ratio: 2.2; 95% confidence interval: 1.9 to 2.7; p <0.001) after surgery. Conclusions Additional post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and ≥180 days after noncardiac surgery compared with a pre-operative NP measurement alone.

Original languageEnglish
Pages (from-to)170-180
Number of pages11
JournalJournal of the American College of Cardiology
Volume63
Issue number2
DOIs
Publication statusPublished - Jan 21 2014

Keywords

  • anesthesia
  • myocardial infarction
  • natriuretic peptides
  • risk factors
  • surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Rodseth, R. N., Biccard, B. M., Le Manach, Y., Sessler, D. I., Lurati Buse, G. A., Thabane, L., Schutt, R. C., Bolliger, D., Cagini, L., Cardinale, D., Chong, C. P. W., Chu, R., Cnotliwy, M., Di Somma, S., Fahrner, R., Lim, W. K., Mahla, E., Manikandan, R., Puma, F., ... Devereaux, P. J. (2014). The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: A systematic review and individual patient data meta-analysis. Journal of the American College of Cardiology, 63(2), 170-180. https://doi.org/10.1016/j.jacc.2013.08.1630