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Prognostic value of brain natriuretic peptide in noncardiac surgery: a meta-analysis.
Anesthesiology 2009; 111(2):311-9A

Abstract

BACKGROUND

The prognostic role of brain natriuretic peptide (BNP) measurement before noncardiac surgery is unclear. The authors therefore performed a meta-analysis of studies in patients undergoing noncardiac surgery to assess the prognostic value of elevated BNP or N-terminal pro-BNP (NT-proBNP) levels in predicting mortality and major adverse cardiovascular events (MACE) (cardiac death or nonfatal myocardial infarction).

METHODS

Unrestricted searches of MEDLINE and EMBASE bibliographic databases were performed using the terms "brain natriuretic peptide," "b-type natriuretic peptide," "BNP," "NT-proBNP," and "surgery." In addition, review articles, bibliographies, and abstracts of scientific meetings were manually searched. The meta-analysis included prospective studies that reported on the association of BNP or NT-proBNP and postoperative major adverse cardiovascular event (MACE) or mortality. The study endpoints were MACE, all-cause mortality, and cardiac mortality at short-term (less than 43 days after surgery) and longer-term (more than 6 months) follow-up. A random-effects model was used to pool study results; funnel-plot inspection was done to evaluate publication bias; Cochrane chi-square test and I testing was used to test for heterogeneity.

RESULTS

Data from 15 publications (4,856 patients) were included in the analysis. Preoperative BNP elevation was associated with an increased risk of short-term MACE (OR 19.77; 95% confidence interval [CI] 13.18-29.65; P < 0.0001), all-cause mortality (OR 9.28; 95% CI 3.51-24.56; P < 0.0001), and cardiac death (OR 23.88; 95% CI 9.43-60.43; P < 0.00001). Results were consistent for both BNP and NT-proBNP. Preoperative BNP elevation was also associated with an increased risk of long-term MACE (OR 17.70; 95% CI 3.11-100.80; P < 0.0001) and all-cause mortality (OR 4.77; 95% CI 2.99-7.46; P < 0.00001).

CONCLUSIONS

Elevated BNP and NT-proBNP levels identify patients undergoing major noncardiac surgery at high risk of cardiac mortality, all-cause mortality, and MACE.

Authors+Show Affiliations

Norfolk and Norwich University Hospital, Norwich, Norfolk, United Kingdom. aryding@doctors.org.ukNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

19602961

Citation

Ryding, Alisdair D S., et al. "Prognostic Value of Brain Natriuretic Peptide in Noncardiac Surgery: a Meta-analysis." Anesthesiology, vol. 111, no. 2, 2009, pp. 311-9.
Ryding AD, Kumar S, Worthington AM, et al. Prognostic value of brain natriuretic peptide in noncardiac surgery: a meta-analysis. Anesthesiology. 2009;111(2):311-9.
Ryding, A. D., Kumar, S., Worthington, A. M., & Burgess, D. (2009). Prognostic value of brain natriuretic peptide in noncardiac surgery: a meta-analysis. Anesthesiology, 111(2), pp. 311-9. doi:10.1097/ALN.0b013e3181aaeb11.
Ryding AD, et al. Prognostic Value of Brain Natriuretic Peptide in Noncardiac Surgery: a Meta-analysis. Anesthesiology. 2009;111(2):311-9. PubMed PMID: 19602961.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic value of brain natriuretic peptide in noncardiac surgery: a meta-analysis. AU - Ryding,Alisdair D S, AU - Kumar,Saurabh, AU - Worthington,Angela M, AU - Burgess,David, PY - 2009/7/16/entrez PY - 2009/7/16/pubmed PY - 2009/8/26/medline SP - 311 EP - 9 JF - Anesthesiology JO - Anesthesiology VL - 111 IS - 2 N2 - BACKGROUND: The prognostic role of brain natriuretic peptide (BNP) measurement before noncardiac surgery is unclear. The authors therefore performed a meta-analysis of studies in patients undergoing noncardiac surgery to assess the prognostic value of elevated BNP or N-terminal pro-BNP (NT-proBNP) levels in predicting mortality and major adverse cardiovascular events (MACE) (cardiac death or nonfatal myocardial infarction). METHODS: Unrestricted searches of MEDLINE and EMBASE bibliographic databases were performed using the terms "brain natriuretic peptide," "b-type natriuretic peptide," "BNP," "NT-proBNP," and "surgery." In addition, review articles, bibliographies, and abstracts of scientific meetings were manually searched. The meta-analysis included prospective studies that reported on the association of BNP or NT-proBNP and postoperative major adverse cardiovascular event (MACE) or mortality. The study endpoints were MACE, all-cause mortality, and cardiac mortality at short-term (less than 43 days after surgery) and longer-term (more than 6 months) follow-up. A random-effects model was used to pool study results; funnel-plot inspection was done to evaluate publication bias; Cochrane chi-square test and I testing was used to test for heterogeneity. RESULTS: Data from 15 publications (4,856 patients) were included in the analysis. Preoperative BNP elevation was associated with an increased risk of short-term MACE (OR 19.77; 95% confidence interval [CI] 13.18-29.65; P < 0.0001), all-cause mortality (OR 9.28; 95% CI 3.51-24.56; P < 0.0001), and cardiac death (OR 23.88; 95% CI 9.43-60.43; P < 0.00001). Results were consistent for both BNP and NT-proBNP. Preoperative BNP elevation was also associated with an increased risk of long-term MACE (OR 17.70; 95% CI 3.11-100.80; P < 0.0001) and all-cause mortality (OR 4.77; 95% CI 2.99-7.46; P < 0.00001). CONCLUSIONS: Elevated BNP and NT-proBNP levels identify patients undergoing major noncardiac surgery at high risk of cardiac mortality, all-cause mortality, and MACE. SN - 1528-1175 UR - https://www.unboundmedicine.com/medline/citation/19602961/Prognostic_value_of_brain_natriuretic_peptide_in_noncardiac_surgery:_a_meta_analysis_ L2 - http://anesthesiology.pubs.asahq.org/article.aspx?doi=10.1097/ALN.0b013e3181aaeb11 DB - PRIME DP - Unbound Medicine ER -