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B-type natriuretic peptide predicts cardiac morbidity and mortality after major surgery

2007; Oxford University Press; Volume: 94; Issue: 7 Linguagem: Inglês

10.1002/bjs.5690

1365-2168

Simon C. Gibson, Christopher J. Payne, Deborah Byrne, Colin Berry, Henry J. Dargie, David Kingsmore,

Heart Failure Treatment and Management

Abstract Background The objective of this study was to determine whether measurement of B-type natriuretic peptide (BNP) concentration before operation could be used to predict perioperative cardiac morbidity. Methods A prospective derivation study was performed in high-risk patients undergoing major non-cardiac surgery, with a subsequent validation study. A venous blood sample was taken the day before surgery for measurement of plasma BNP concentration. Screening for cardiac events (non-fatal myocardial infarction and cardiac death) was performed using clinical criteria, cardiac troponin I analysis and serial electrocardiography. Results Forty-one patients were recruited to the derivation cohort and 149 to the validation cohort. In the derivation cohort, the median (interquartile range) BNP concentration in the 11 patients who had a postoperative cardiac event was 210 (165–380) pg/ml, compared with 34·5 (14–70) pg/ml in those with no cardiac complications (P < 0·001). In the validation cohort, the median BNP concentration in the 15 patients who had a cardiac event was 351 (127–1034) pg/ml, compared with 30·5 (11–79·5) pg/ml in the remainder (P < 0·001). BNP concentration remained a significant outcome predictor in multivariable analysis (P < 0·001). Using receiver–operator curve analysis it was calculated that a BNP concentration of 108·5 pg/ml best predicted the likelihood of cardiac events, with a sensitivity and specificity of 87 per cent each. Conclusion Preoperative serum BNP concentration predicted postoperative cardiac events in patients undergoing major non-cardiac surgery independently of other risk factors.