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Postoperative increase in B-type natriuretic peptide levels predicts adverse outcome after cardiac surgery.
J Cardiothorac Vasc Anesth. 2011 Jun; 25(3):469-75.JC

Abstract

OBJECTIVE

To evaluate the prognostic implication of changes in postoperative B-type natriuretic peptide (BNP) concentrations in patients undergoing cardiopulmonary bypass for cardiac surgery.

DESIGN

A retrospective analysis of prospectively collected clinical data.

SETTING

Cardiothoracic surgery and an intensive care unit (ICU) in a university hospital.

PARTICIPANTS

The present study included a total of 407 consecutive patients undergoing cardiac surgery.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

BNP concentrations were measured on admittance to the ICU (D0) and at day 1 after surgery. Patients were divided into quintiles according to their BNP level on admittance to the ICU. The predictive value of absolute changes in BNP levels during the first 24 hours postoperatively was analyzed with Kaplan-Meier estimates of survival and Cox multivariate proportional analysis. Prognostic factors for impaired midterm survival included elevation of the BNP level (HR, 7.3/ log10(x); 95% confidence interval, 1.8-29, p = 0.005). The BNP levels of patients undergoing isolated valve surgery or valve and concomitant CABG surgery were significantly higher (p = 0.012 and p = 0.032, respectively) than those undergoing isolated coronary artery bypass graft surgery. Patients in higher quintiles required ventilation for a longer time (p < 0.001), and prolonged inotropic support (p < 0.001). The mean plasma BNP concentration of 172 pg/mL (median, 64; interquartile range, 172) on arrival at the ICU had a sensitivity of 75% and a specificity of 74% for predicting 1-year mortality.

CONCLUSIONS

Elevated BNP levels on admittance to the ICU and postoperatively increasing BNP levels are associated with adverse postoperative outcome and are predictive of impaired late survival. Sequential postoperative BNP monitoring facilitates the early identification of patients at an increased risk of heart failure and may be used as an adjunct for clinical decision making and optimized patient management.

Authors+Show Affiliations

Department of Cardiothoracic Surgery, Heart and Lung Division, Skane University Hospital, Lund, Sweden. shahab.nozohoor@med.lu.seNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20829070

Citation

Nozohoor, Shahab, et al. "Postoperative Increase in B-type Natriuretic Peptide Levels Predicts Adverse Outcome After Cardiac Surgery." Journal of Cardiothoracic and Vascular Anesthesia, vol. 25, no. 3, 2011, pp. 469-75.
Nozohoor S, Nilsson J, Algotsson L, et al. Postoperative increase in B-type natriuretic peptide levels predicts adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth. 2011;25(3):469-75.
Nozohoor, S., Nilsson, J., Algotsson, L., & Sjögren, J. (2011). Postoperative increase in B-type natriuretic peptide levels predicts adverse outcome after cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia, 25(3), 469-75. https://doi.org/10.1053/j.jvca.2010.07.002
Nozohoor S, et al. Postoperative Increase in B-type Natriuretic Peptide Levels Predicts Adverse Outcome After Cardiac Surgery. J Cardiothorac Vasc Anesth. 2011;25(3):469-75. PubMed PMID: 20829070.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postoperative increase in B-type natriuretic peptide levels predicts adverse outcome after cardiac surgery. AU - Nozohoor,Shahab, AU - Nilsson,Johan, AU - Algotsson,Lars, AU - Sjögren,Johan, Y1 - 2010/09/09/ PY - 2010/04/29/received PY - 2010/9/11/entrez PY - 2010/9/11/pubmed PY - 2012/4/13/medline SP - 469 EP - 75 JF - Journal of cardiothoracic and vascular anesthesia JO - J Cardiothorac Vasc Anesth VL - 25 IS - 3 N2 - OBJECTIVE: To evaluate the prognostic implication of changes in postoperative B-type natriuretic peptide (BNP) concentrations in patients undergoing cardiopulmonary bypass for cardiac surgery. DESIGN: A retrospective analysis of prospectively collected clinical data. SETTING: Cardiothoracic surgery and an intensive care unit (ICU) in a university hospital. PARTICIPANTS: The present study included a total of 407 consecutive patients undergoing cardiac surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: BNP concentrations were measured on admittance to the ICU (D0) and at day 1 after surgery. Patients were divided into quintiles according to their BNP level on admittance to the ICU. The predictive value of absolute changes in BNP levels during the first 24 hours postoperatively was analyzed with Kaplan-Meier estimates of survival and Cox multivariate proportional analysis. Prognostic factors for impaired midterm survival included elevation of the BNP level (HR, 7.3/ log10(x); 95% confidence interval, 1.8-29, p = 0.005). The BNP levels of patients undergoing isolated valve surgery or valve and concomitant CABG surgery were significantly higher (p = 0.012 and p = 0.032, respectively) than those undergoing isolated coronary artery bypass graft surgery. Patients in higher quintiles required ventilation for a longer time (p < 0.001), and prolonged inotropic support (p < 0.001). The mean plasma BNP concentration of 172 pg/mL (median, 64; interquartile range, 172) on arrival at the ICU had a sensitivity of 75% and a specificity of 74% for predicting 1-year mortality. CONCLUSIONS: Elevated BNP levels on admittance to the ICU and postoperatively increasing BNP levels are associated with adverse postoperative outcome and are predictive of impaired late survival. Sequential postoperative BNP monitoring facilitates the early identification of patients at an increased risk of heart failure and may be used as an adjunct for clinical decision making and optimized patient management. SN - 1532-8422 UR - https://www.unboundmedicine.com/medline/citation/20829070/Postoperative_increase_in_B_type_natriuretic_peptide_levels_predicts_adverse_outcome_after_cardiac_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-0770(10)00290-9 DB - PRIME DP - Unbound Medicine ER -