A prospective observational study of preoperative natriuretic peptide testing in adult non-cardiac surgical patients in hospitals in Western Cape Province, South Africa
| Autor: | C S, Alphonsus, M, Jagga, M, Crowther, E, Coetzee, G, Davies, Z, Fullerton, H A, Van Zyl, A, Reed, E, Cloete, J, Roos, F, Roodt, R N, Rodseth, B M, Biccard, A, Parak |
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| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_class medicine.medical_treatment Disease Coronary artery disease South Africa chemistry.chemical_compound Postoperative Complications Internal medicine Diabetes mellitus Natriuretic Peptide Brain Preoperative Care Natriuretic peptide Humans Medicine Prospective Studies Stroke Aged Creatinine business.industry Vascular disease Insulin General Medicine Middle Aged medicine.disease Peptide Fragments chemistry Heart Disease Risk Factors Surgical Procedures Operative Female business |
| Zdroj: | South African Medical Journal; Vol. 111 No. 4 (2021); 338-342 |
| ISSN: | 2078-5135 0256-9574 |
| Popis: | Background. International guidelines recommend risk stratification to identify high-risk non-cardiac surgical patients. It is also recommended that all patients aged ≥45 years with significant cardiovascular disease should have preoperative natriuretic peptide (NP) testing. Abnormal preoperative B-type NPs have a strong association with postoperative cardiac complications. In South African hospitals, it is not known how many patients with significant cardiovascular disease scheduled for intermediate- to high-risk surgery will have raised NPs. Objectives. To determine the prevalence of abnormal (raised) NPs in non-cardiac surgical patients with cardiac clinical risk factors. A secondary objective was to develop a model to identify surgical patients who may benefit from preoperative NP screening. Methods. The inclusion criteria were patients aged ≥45 years presenting for elective, non-obstetric, intermediate- to high-risk non-cardiac surgery with at least one of the following cardiovascular risk factors: a history of ischaemic heart disease or peripheral vascular disease (coronary equivalent); a history of stroke or transient ischaemic attack; a history of congestive cardiac failure; diabetes mellitus currently on an oral hypoglycaemic agent or insulin; and serum creatinine level >175 µmol/L (>2.0 mg/dL). Blood samples for N-terminal-prohormone B-type NP (NT-proBNP) were collected before induction of anaesthesia. The preoperative prognostic threshold for abnormal (raised) NT-proBNP was ≥300 pg/mL. A generalised linear mixed model was used to determine the association between the risk factors and an abnormal NT-proBNP level. Results. Of 172 patients, 63 (37%) had an elevated preoperative NT-proBNP level. The comorbidities independently associated with elevated preoperative NT-proBNP were coronary artery disease or peripheral vascular disease, congestive cardiac failure, diabetes mellitus, and a creatinine level >175 µmol/L. Conclusions. We strongly recommend that non-cardiac surgical patients aged ≥45 years undergoing intermediate- or high-risk non-cardiac surgery with a history of coronary artery disease/peripheral vascular disease, congestive cardiac failure, diabetes mellitus or elevated creatinine have preoperative NP testing as part of risk stratification. |
| Databáze: | OpenAIRE |
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