NT-proBNP incorporated in prediction rule of major peri-operative adverse cardiac event in non-cardiac surgery

Autor: Muhammed Khaled Elfaituri, Tran Thai Huu Loc, Le Huu Nhat Minh, Nguyen Lam Vuong, Truong Quang Binh, Nguyen Tien Huy, Nguyen Van Khoi, Mohamed Gomaa Kamel, Do Van Trang
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
Adolescent
Heart Diseases
Revised Cardiac Risk Index
medicine.drug_class
030204 cardiovascular system & hematology
Logistic regression
Risk Assessment
Young Adult
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Risk Factors
Clinical Decision Rules
Internal medicine
Natriuretic Peptide
Brain
Natriuretic peptide
Humans
Medicine
Prospective Studies
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Prospective cohort study
Aged
Aged
80 and over
Framingham Risk Score
Receiver operating characteristic
business.industry
Perioperative
Middle Aged
Prognosis
medicine.disease
Peptide Fragments
Logistic Models
ROC Curve
Preoperative Period
Cardiology
Female
Surgery
business
Biomarkers
hormones
hormone substitutes
and hormone antagonists
Zdroj: The Surgeon. 17:127-132
ISSN: 1479-666X
Popis: Background Patients undergoing non-cardiac surgery are at risk for peri-operative major cardiac events (PMCEs). The most common risk assessment tool is Revised Cardiac Risk Index (RCRI). N-terminal pro-brain natriuretic peptide (NT-proBNP) measured peri-operatively has prognostic information but the implication is uncertain. This study aimed to determine the accuracy of combining NT-proBNP and RCRI in predicting the PMCE in major non-cardiac surgery. Methods We performed a prospective cohort study to include non-cardiac surgical patients with moderate or high risk. PMCE included myocardial infarction, pulmonary edema, severe cardiac arrhythmias, and cardiac death occurring within 30 days post-operatively. Logistic regression models and the receiver operating characteristic (ROC) curves were used to determine the discriminative ability of NT-proBNP alone or incorporation with RCRI or its components in predicting PMCE. Results A total of 366 patients was included in the study with 48 PMCEs. When predicting PMCE, the area under the ROC curve (AUC) (95%-CI) of NT-proBNP alone and NT-proBNP incorporated with RCRI were 0.875 (0.819–0.932) and 0.882 (0.827–0.937), respectively. When incorporating NT-proBNP with the RCRI's components, the best four chosen models had the AUCs between 0.879 and 0.891. All these AUCs were not significantly different with the AUC of NT-proBNP alone. Conclusions Higher preoperative NT-proBNP level leads to the increased risk of PMCE in patients undergoing non-cardiac surgery. Compared to NT-proBNP alone, the combination of NT-proBNP with the RCRI and other factors does not improve the accuracy in predicting PMCE. Future large studies are required to build a more accurate risk score.
Databáze: OpenAIRE
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