1. The Prognostic Value of Pre-Operative and Post-Operative B-Type Natriuretic Peptides in Patients Undergoing Noncardiac Surgery: B-Type Natriuretic Peptide and N-Terminal Fragment of Pro-B-Type Natriuretic Peptide: A Systematic Review and Individual Patient Data Meta-Analysis.
- Author
-
Rodseth, Reitze N., Biccard, Bruce M., Le Manach, Yannick, Sessler, Daniel I., Lurati Buse, Giovana A., Thabane, Lehana, Schutt, Robert C., Bolliger, Daniel, Cagini, Lucio, Cardinale, Daniela, Chong, Carol P.W., Chu, Rong, Cnotliwy, Miłosław, Di Somma, Salvatore, Fahrner, René, Lim, Wen Kwang, Mahla, Elisabeth, Manikandan, Ramaswamy, Puma, Francesco, and Pyun, Wook B.
- Subjects
- *
NATRIURETIC peptides , *SYSTEMATIC reviews , *CARDIOVASCULAR diseases , *MYOCARDIAL infarction , *OPERATIVE surgery , *CONFIDENCE intervals , *META-analysis - Abstract
Objectives: The objective of this study was to determine whether measuring post-operative B-type natriuretic peptides (NPs) (i.e., B-type natriuretic peptide [BNP] and N-terminal fragment of proBNP [NT-proBNP]) enhances risk stratification in adult patients undergoing noncardiac surgery, in whom a pre-operative NP has been measured. Background: Pre-operative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated post-operative NP concentrations are independently associated with these complications. It is not clear whether there is value in measuring post-operative NP when a pre-operative measurement has been done. Methods: We conducted a systematic review and individual patient data meta-analysis to determine whether the addition of post-operative NP levels enhanced the prediction of the composite of death and nonfatal myocardial infarction at 30 and ≥180 days after surgery. Results: Eighteen eligible studies provided individual patient data (n = 2,179). Adding post-operative NP to a risk prediction model containing pre-operative NP improved model fit and risk classification at both 30 days (corrected quasi-likelihood under the independence model criterion: 1,280 to 1,204; net reclassification index: 20%; p < 0.001) and ≥180 days (corrected quasi-likelihood under the independence model criterion: 1,320 to 1,300; net reclassification index: 11%; p = 0.003). Elevated post-operative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio: 3.7; 95% confidence interval: 2.2 to 6.2; p < 0.001) and ≥180 days (odds ratio: 2.2; 95% confidence interval: 1.9 to 2.7; p < 0.001) after surgery. Conclusions: Additional post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and ≥180 days after noncardiac surgery compared with a pre-operative NP measurement alone. [Copyright &y& Elsevier]
- Published
- 2014
- Full Text
- View/download PDF