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 |
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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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