Pre-operative N-terminal pro-B-type natriuretic peptide for prediction of acute kidney injury after noncardiac surgery: A retrospective cohort study.

Autor:	Zhao BC; From the Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China (B-CZ, P-PZ, S-HL, S-DQ, XY, CL, W-FL, K-XL)., Zhuang PP, Lei SH, Qiu SD, Yang X, Li C, Liu WF, Liu KX
Jazyk:	angličtina
Zdroj:	European journal of anaesthesiology [Eur J Anaesthesiol] 2021 Jun 01; Vol. 38 (6), pp. 591-599.
DOI:	10.1097/EJA.0000000000001495
Abstrakt:	Background: Acute kidney injury (AKI) is associated with poor outcomes after noncardiac surgery. Whether pre-operative N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts AKI after noncardiac surgery is unclear. Objective: To investigate the predictive role of pre-operative NT-proBNP on postoperative AKI. Design: Retrospective cohort study. Setting: Nanfang Hospital, Southern Medical University, China. Patients: Adult patients who had a serum creatinine and NT-proBNP measurement within 30 pre-operative days and at least one serum creatinine measurement within 7 days after noncardiac surgery between February 2008 and May 2018 were identified. Main Outcome Measures: The primary outcome was postoperative AKI, defined by the kidney disease: improving global outcomes creatinine criteria. Results: In all, 6.1% (444 of 7248) of patients developed AKI within 1 week after surgery. Pre-operative NT-proBNP was an independent predictor of AKI after adjustment for clinical variables (OR comparing top to bottom quintiles 2.29, 95% CI, 1.47 to 3.65, P < 0.001 for trend; OR per 1-unit increment in natural log transformed NT-proBNP 1.27, 95% CI, 1.16 to 1.39). Compared with clinical variables alone, the addition of NT-proBNP improved model fit, modestly improved the discrimination (change in area under the curve from 0.764 to 0.773, P = 0.005) and reclassification (continuous net reclassification improvement 0.210, 95% CI, 0.111 to 0.308, improved integrated discrimination 0.0044, 95% CI, 0.0016 to 0.0072) of AKI and non-AKI cases, and achieved higher net benefit in decision curve analysis. Conclusions: Pre-operative NT-proBNP concentrations provided predictive information for AKI in a cohort of patients undergoing noncardiac surgery, independent of and incremental to conventional risk factors. Prospective studies are required to confirm this finding and examine its clinical impact. Trial Registration: Chinese Clinical Trial Registry, ChiCTR1900024056. www.chictr.org.cn/showproj.aspx?proj=40385. (Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.)
Databáze:	MEDLINE
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