Postoperative B-type Natriuretic Peptide for Prediction of Major Cardiac Events in Patients Undergoing Noncardiac Surgery
| Autor: | Thuvaraha Vanniyasingam, Lehana Thabane, Daniel I. Sessler, Carol P Chong, Elisabeth Mahla, Wen Kwang Lim, Wook Bum Pyun, Marek Waliszek, Bruce M Biccard, Giovana A. Lurati Buse, Sriram Rajagopalan, René Fahrner, Philip J. Devereaux, Daniel Bolliger, Thomas J. Cahill, Reitze N. Rodseth, Rong Chu, Daniela Cardinale, Salvatore Di Somma, Yannick Le Manach, Robert C. Schutt, Milan Radovic, Ameet Bakhai, Miłosław Cnotliwy, Stuart Suttie, Lucio Cagini, Ramaswamy Manikandan |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class business.industry Area under the curve Odds ratio 030204 cardiovascular system & hematology medicine.disease Brain natriuretic peptide 3. Good health 03 medical and health sciences 0302 clinical medicine Anesthesiology and Pain Medicine 030202 anesthesiology Heart failure Internal medicine Meta-analysis medicine Natriuretic peptide Cardiology Myocardial infarction business Noncardiac surgery |
| Zdroj: | Anesthesiology. 119:270-283 |
| ISSN: | 0003-3022 |
| DOI: | 10.1097/aln.0b013e31829083f1 |
| Popis: | Background: It is unclear whether postoperative B-type natriuretic peptides (i.e., BNP and N-terminal proBNP) can predict cardiovascular complications in noncardiac surgery. Methods: The authors undertook a systematic review and individual patient data meta-analysis to determine whether postoperative BNPs predict postoperative cardiovascular complications at 30 and 180 days or more. Results: The authors identified 18 eligible studies (n = 2,051). For the primary outcome of 30-day mortality or nonfatal myocardial infarction, BNP of 245 pg/ml had an area under the curve of 0.71 (95% CI, 0.64–0.78), and N-terminal proBNP of 718 pg/ml had an area under the curve of 0.80 (95% CI, 0.77–0.84). These thresholds independently predicted 30-day mortality or nonfatal myocardial infarction (adjusted odds ratio [AOR] 4.5; 95% CI, 2.74–7.4; P < 0.001), mortality (AOR, 4.2; 95% CI, 2.29–7.69; P < 0.001), cardiac mortality (AOR, 9.4; 95% CI, 0.32–254.34; P < 0.001), and cardiac failure (AOR, 18.5; 95% CI, 4.55–75.29; P < 0.001). For greater than or equal to 180-day outcomes, natriuretic peptides independently predicted mortality or nonfatal myocardial infarction (AOR, 3.3; 95% CI, 2.58–4.3; P < 0.001), mortality (AOR, 2.2; 95% CI, 1.67–86; P < 0.001), cardiac mortality (AOR, 2.1; 95% CI, 0.05–1,385.17; P < 0.001), and cardiac failure (AOR, 3.5; 95% CI, 1.0–9.34; P = 0.022). Patients with BNP values of 0–250, greater than 250–400, and greater than 400 pg/ml suffered the primary outcome at a rate of 6.6, 15.7, and 29.5%, respectively. Patients with N-terminal proBNP values of 0–300, greater than 300–900, and greater than 900 pg/ml suffered the primary outcome at a rate of 1.8, 8.7, and 27%, respectively. Conclusions: Increased postoperative BNPs are independently associated with adverse cardiac events after noncardiac surgery. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|