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The interrelationship between preoperative anemia and N-terminal pro-B-type natriuretic peptide: the effect on predicting postoperative cardiac outcome in vascular surgery patients.
Anesth Analg. 2009 Nov; 109(5):1403-8.A&A

Abstract

INTRODUCTION

N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts adverse cardiac outcome in patients undergoing vascular surgery. However, several conditions might influence this prognostic value, including anemia. In this study, we evaluated whether anemia confounds the prognostic value of NT-proBNP for predicting cardiac events in patients undergoing vascular surgery.

METHODS

A detailed cardiac history, resting echocardiography, and hemoglobin and NT-proBNP levels were obtained in 666 patients before vascular surgery. Anemia was defined as serum hemoglobin <13 g/dL for men and <12 g/dL for women. Troponin T measurements and 12-lead electrocardiograms were performed on postoperative days 1, 3, 7, and 30 and whenever clinically indicated. The primary end point of the study was the composite of 30-day postoperative cardiovascular death, nonfatal myocardial infarction, and troponin T release. Receiver operating characteristic curve analysis was used to assess the optimal cutoff value of NT-proBNP for the prediction of the composite end point. Multivariable regression analysis was used to assess the additional value of NT-proBNP for the prediction of postoperative cardiac events in nonanemic and anemic patients.

RESULTS

Anemia was present in 206 patients (31%) before surgery. Hemoglobin level was inversely related with the NT-proBNP levels (beta coefficient = -2.242; P = 0.025). The optimal predictive cutoff value of NT-proBNP for predicting the composite cardiovascular outcome was 350 pg/mL. After adjustment for clinical cardiac risk factors, both anemia (odds ratio [OR] 1.53; 95% confidence interval [CI]: 1.07-2.99) and increased levels of NT-proBNP (OR 4.09; 95% CI: 2.19-7.64) remained independent predictors for postoperative cardiac events. However, increased levels of NT-proBNP were not predictive for the risk of adverse cardiac events in the subgroup of anemic patients (OR 2.16; 95% CI: 0.90-5.21).

CONCLUSIONS

Both anemia and NT-proBNP are independently associated with an increased risk for postoperative cardiac events in patients undergoing vascular surgery. NT-proBNP has less predictive value in anemic patients.

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Authors+Show Affiliations

Goei D
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Flu WJ
No affiliation info available
Hoeks SE
No affiliation info available
Galal W
No affiliation info available
Dunkelgrun M
No affiliation info available
Boersma E
No affiliation info available
Kuijper R
No affiliation info available
van Kuijk JP
No affiliation info available
Winkel TA
No affiliation info available
Schouten O
No affiliation info available
Bax JJ
No affiliation info available
Poldermans D
No affiliation info available

MeSH

AgedAnemiaBiomarkersElectrocardiographyFemaleHeart DiseasesHemoglobinsHumansLinear ModelsMaleMiddle AgedNatriuretic Peptide, BrainOdds RatioPeptide FragmentsPredictive Value of TestsROC CurveRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeTroponin TVascular Surgical Procedures

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19843778

Citation

Goei, Dustin, et al. "The Interrelationship Between Preoperative Anemia and N-terminal pro-B-type Natriuretic Peptide: the Effect On Predicting Postoperative Cardiac Outcome in Vascular Surgery Patients." Anesthesia and Analgesia, vol. 109, no. 5, 2009, pp. 1403-8.
Goei D, Flu WJ, Hoeks SE, et al. The interrelationship between preoperative anemia and N-terminal pro-B-type natriuretic peptide: the effect on predicting postoperative cardiac outcome in vascular surgery patients. Anesth Analg. 2009;109(5):1403-8.
Goei, D., Flu, W. J., Hoeks, S. E., Galal, W., Dunkelgrun, M., Boersma, E., Kuijper, R., van Kuijk, J. P., Winkel, T. A., Schouten, O., Bax, J. J., & Poldermans, D. (2009). The interrelationship between preoperative anemia and N-terminal pro-B-type natriuretic peptide: the effect on predicting postoperative cardiac outcome in vascular surgery patients. Anesthesia and Analgesia, 109(5), 1403-8. https://doi.org/10.1213/ANE.0b013e3181b893dd
Goei D, et al. The Interrelationship Between Preoperative Anemia and N-terminal pro-B-type Natriuretic Peptide: the Effect On Predicting Postoperative Cardiac Outcome in Vascular Surgery Patients. Anesth Analg. 2009;109(5):1403-8. PubMed PMID: 19843778.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The interrelationship between preoperative anemia and N-terminal pro-B-type natriuretic peptide: the effect on predicting postoperative cardiac outcome in vascular surgery patients. AU - Goei,Dustin, AU - Flu,Willem-Jan, AU - Hoeks,Sanne E, AU - Galal,Wael, AU - Dunkelgrun,Martin, AU - Boersma,Eric, AU - Kuijper,Ruud, AU - van Kuijk,Jan-Peter, AU - Winkel,Tamara A, AU - Schouten,Olaf, AU - Bax,Jeroen J, AU - Poldermans,Don, PY - 2009/10/22/entrez PY - 2009/10/22/pubmed PY - 2009/11/6/medline SP - 1403 EP - 8 JF - Anesthesia and analgesia JO - Anesth Analg VL - 109 IS - 5 N2 - INTRODUCTION: N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts adverse cardiac outcome in patients undergoing vascular surgery. However, several conditions might influence this prognostic value, including anemia. In this study, we evaluated whether anemia confounds the prognostic value of NT-proBNP for predicting cardiac events in patients undergoing vascular surgery. METHODS: A detailed cardiac history, resting echocardiography, and hemoglobin and NT-proBNP levels were obtained in 666 patients before vascular surgery. Anemia was defined as serum hemoglobin <13 g/dL for men and <12 g/dL for women. Troponin T measurements and 12-lead electrocardiograms were performed on postoperative days 1, 3, 7, and 30 and whenever clinically indicated. The primary end point of the study was the composite of 30-day postoperative cardiovascular death, nonfatal myocardial infarction, and troponin T release. Receiver operating characteristic curve analysis was used to assess the optimal cutoff value of NT-proBNP for the prediction of the composite end point. Multivariable regression analysis was used to assess the additional value of NT-proBNP for the prediction of postoperative cardiac events in nonanemic and anemic patients. RESULTS: Anemia was present in 206 patients (31%) before surgery. Hemoglobin level was inversely related with the NT-proBNP levels (beta coefficient = -2.242; P = 0.025). The optimal predictive cutoff value of NT-proBNP for predicting the composite cardiovascular outcome was 350 pg/mL. After adjustment for clinical cardiac risk factors, both anemia (odds ratio [OR] 1.53; 95% confidence interval [CI]: 1.07-2.99) and increased levels of NT-proBNP (OR 4.09; 95% CI: 2.19-7.64) remained independent predictors for postoperative cardiac events. However, increased levels of NT-proBNP were not predictive for the risk of adverse cardiac events in the subgroup of anemic patients (OR 2.16; 95% CI: 0.90-5.21). CONCLUSIONS: Both anemia and NT-proBNP are independently associated with an increased risk for postoperative cardiac events in patients undergoing vascular surgery. NT-proBNP has less predictive value in anemic patients. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/19843778/The_interrelationship_between_preoperative_anemia_and_N_terminal_pro_B_type_natriuretic_peptide:_the_effect_on_predicting_postoperative_cardiac_outcome_in_vascular_surgery_patients_ L2 - https://doi.org/10.1213/ANE.0b013e3181b893dd DB - PRIME DP - Unbound Medicine ER -
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