N-terminal pro-B-type natriuretic peptide levels and early outcome after cardiac surgery: a prospective cohort study

Brian H Cuthbertson, Bernard L Croal, Daniela Rae, Patrick Gibson, Jane McNeilly, Robert Jeffrey, W Cairns Smith, Gordon J Prescott, Keith Buchan, Hussein El-Shafei, George A Gibson, Graham Hillis

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Abstract

Background. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a powerful predictor of cardiovascular outcome in many circumstances. There are, however, limited data regarding the utility of NT-proBNP or BNP levels in patients undergoing cardiac surgery. The current study assesses the ability of NT-proBNP to predict early outcome in this setting.
Methods. One thousand and ten patients undergoing non-emergent cardiac surgery were recruited prospectively. Baseline clinical details were obtained and the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Parsonnet score were calculated. Preoperative NT-proBNP levels were measured using the Roche Elecsys assay. The primary endpoint was 30 day mortality.

Results. Median NT-proBNP levels were 624 ng litre(-1) among patients who died within 30 days of surgery (n=29), compared with 279 ng litre(-1) in survivors [odds ratio (OR) 1.03 per 250 ng litre(-1), 95% confidence interval 1.01-1.05, P=0.001). NT-proBNP levels remained predictors of 30 day mortality in models including either the additive EuroSCORE (OR 1.03 per 250 ng litre(-1), P=0.01), the logistic EuroSCORE (OR 1.03 per 250 ng litre(-1), P=0.004), or the Parsonnet score (OR 1.02 per 250 ng litre(-1), P=0.04). Levels of NT-proBNP were also predictors of prolonged (>1 day) stay in the intensive care unit (OR 1.03 per 250 ng litre(-1), P<0.001) and of a hospital stay >1 week (OR 1.07 per 250 ng litre(-1), P<0.001). They remained predictive of these outcomes in regression models that included either the EuroSCORE or the Parsonnet score and in a model that included all study variables.

Conclusions. NT-proBNP levels predict early outcome after cardiac surgery. Their prognostic utility is modest-but is independent of traditional indicators and conventional risk prediction scores.
Original languageEnglish
Pages (from-to)647-653
Number of pages7
JournalBritish Journal of Anaesthesia
Volume103
Issue number5
Early online date27 Aug 2009
DOIs
Publication statusPublished - Nov 2009

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Keywords

  • complications
  • death
  • complications, morbidity
  • hormones, atrial natriuretic peptide
  • surgery, cardiovascular
  • major non-cardiac surgery
  • heart-failure
  • risk
  • utility
  • mortality
  • euroscore
  • BNP

Cite this

Cuthbertson, B. H., Croal, B. L., Rae, D., Gibson, P., McNeilly, J., Jeffrey, R., ... Hillis, G. (2009). N-terminal pro-B-type natriuretic peptide levels and early outcome after cardiac surgery: a prospective cohort study. British Journal of Anaesthesia, 103(5), 647-653. https://doi.org/10.1093/bja/aep234