In:
Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 119, No. 2 ( 2013-08-01), p. 270-283
Abstract:
It is unclear whether postoperative B-type natriuretic peptides (i.e., BNP and N-terminal proBNP) can predict cardiovascular complications in noncardiac surgery. Methods: The authors undertook a systematic review and individual patient data meta-analysis to determine whether postoperative BNPs predict postoperative cardiovascular complications at 30 and 180 days or more. Results: The authors identified 18 eligible studies (n = 2,051). For the primary outcome of 30-day mortality or nonfatal myocardial infarction, BNP of 245 pg/ml had an area under the curve of 0.71 (95% CI, 0.64–0.78), and N-terminal proBNP of 718 pg/ml had an area under the curve of 0.80 (95% CI, 0.77–0.84). These thresholds independently predicted 30-day mortality or nonfatal myocardial infarction (adjusted odds ratio [AOR] 4.5; 95% CI, 2.74–7.4; P & lt; 0.001), mortality (AOR, 4.2; 95% CI, 2.29–7.69; P & lt; 0.001), cardiac mortality (AOR, 9.4; 95% CI, 0.32–254.34; P & lt; 0.001), and cardiac failure (AOR, 18.5; 95% CI, 4.55–75.29; P & lt; 0.001). For greater than or equal to 180-day outcomes, natriuretic peptides independently predicted mortality or nonfatal myocardial infarction (AOR, 3.3; 95% CI, 2.58–4.3; P & lt; 0.001), mortality (AOR, 2.2; 95% CI, 1.67–86; P & lt; 0.001), cardiac mortality (AOR, 2.1; 95% CI, 0.05–1,385.17; P & lt; 0.001), and cardiac failure (AOR, 3.5; 95% CI, 1.0–9.34; P = 0.022). Patients with BNP values of 0–250, greater than 250–400, and greater than 400 pg/ml suffered the primary outcome at a rate of 6.6, 15.7, and 29.5%, respectively. Patients with N-terminal proBNP values of 0–300, greater than 300–900, and greater than 900 pg/ml suffered the primary outcome at a rate of 1.8, 8.7, and 27%, respectively. Conclusions: Increased postoperative BNPs are independently associated with adverse cardiac events after noncardiac surgery.
Type of Medium:
Online Resource
ISSN:
0003-3022
DOI:
10.1097/ALN.0b013e31829083f1
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2013
detail.hit.zdb_id:
2016092-6
Permalink