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 article

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.

  • Rodseth RN Perioperative Research Group, Department of Anaesthetics, Grey's Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa; Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio. Electronic address: ReitzeRodseth@gmail.com.
  • Biccard BM Perioperative Research Group, Department of Anaesthetics, Grey's Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
  • Le Manach Y Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Departments of Anesthesia, Clinical Epidemiology, and Biostatistics, Hamilton Health Sciences, Hamilton, Ontario, Canada.
  • Sessler DI Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.
  • Lurati Buse GA Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
  • Thabane L Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Departments of Clinical Epidemiology and Biostatistics/Anesthesia/Pediatrics, McMaster University, Hamilton, Ontario, Canada; Biostatistics Unit, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
  • Schutt RC Department of Internal Medicine, University of Virginia, Charlottesville, Virginia.
  • Bolliger D Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
  • Cagini L Department of Surgical Science, University of Perugia, Ospedale S. Maria, Perugia, Italy.
  • Cardinale D Cardioncology Unit, European Institute of Oncology, Milan, Italy.
  • Chong CP Departments of Aged Care, Northern Clinical Research Centre, The Northern Hospital, Epping, Victoria, Australia, and The Department of Medicine, Austin and Northern Health, The University of Melbourne, Melbourne, Victoria, Australia.
  • Chu R Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
  • Cnotliwy M Department of Vascular and General Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland.
  • Di Somma S Department of Medical-Surgery Sciences and Translational Medicine, University La Sapienza, and Emergency Department, Sant'Andrea Hospital, Rome, Italy.
  • Fahrner R Division of General, Visceral and Vascular Surgery, University Hospital, Jena, Germany.
  • Lim WK Departments of Aged Care, Northern Clinical Research Centre, The Northern Hospital, Epping, Victoria, Australia, and The Department of Medicine, Austin and Northern Health, The University of Melbourne, Melbourne, Victoria, Australia.
  • Mahla E Department of Anesthesia and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
  • Manikandan R Departments of Urology, Stepping Hill Hospital, Stockport, United Kingdom, and Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom.
  • Puma F Department of Surgical Science, University of Perugia, Ospedale S. Maria, Perugia, Italy.
  • Pyun WB Division of Cardiology, Department of Internal Medicine, Ewha Womans University, School of Medicine, Mokdong Hospital, Seoul, Korea.
  • Radović M Clinic of Nephrology, University of Belgrade, School of Medicine, Belgrade, Serbia.
  • Rajagopalan S Department of Vascular Surgery, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom.
  • Suttie S Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, United Kingdom.
  • Vanniyasingam T Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada.
  • van Gaal WJ Department of Cardiology, University of Melbourne, Northern Health, Epping, Victoria, Australia.
  • Waliszek M Cardiac Diagnostics Unit, M. Pirogow Provincial Specialist Hospital, Lodz, Poland.
  • Devereaux PJ Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Departments of Medicine, Clinical Epidemiology, and Biostatistics, Hamilton Health Sciences, Hamilton, Ontario, Canada.
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  • 2013-10-01
Published in:
  • Journal of the American College of Cardiology. - 2014
English 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.
Language
  • English
Open access status
bronze
Identifiers
Persistent URL
https://sonar.ch/global/documents/53472
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