DOI QR코드

DOI QR Code

Postoperative B-Type Natriuretic Peptide Levels Associated With Prolonged Hospitalization in Hypertensive Patients After Non-Cardiac Surgery

  • Park, Jae-Hong (Division of Cardiology, Department of Internal Medicine, Kang Nam General Hosptial) ;
  • Shin, Gil-Ja (Cardiovascular Center, Department of Internal Medicine, School of Medicine, Ewha Womans Universiy) ;
  • Ryu, Jae-In (Cardiovascular Center, Department of Internal Medicine, School of Medicine, Ewha Womans Universiy) ;
  • Pyun, Wook-Bum (Cardiovascular Center, Department of Internal Medicine, School of Medicine, Ewha Womans Universiy)
  • Published : 2012.08.31

Abstract

Background and Objectives: B-type natriuretic peptide (BNP) is an important marker for the diagnosis of heart failure and is useful towards predicting morbidity and mortality after non-cardiac surgery. Nevertheless, information on the relationship between postoperative BNP levels and perioperative prognosis after non-cardiac surgery is scarce. The purpose of the study was to assess whether postoperative BNP levels could be used as a predictor of prolonged hospitalization in elderly hypertensive patients after non-cardiac surgery. Subjects and Methods: Ninety-seven (97) patients, aged 55 years or older (mean age: $73.12{\pm}10.05$ years, M : F=24 : 73) were enrolled in a prospective study from May 2005 through August 2010. All patients underwent total knee or hip replacement. Postoperative BNP and other diagnostic data were recorded within 24 hours of surgery. Patients that required a prolonged hospital stay due to operative causes, such as wound infection and re-operation, were excluded. Results: The length of hospital stay was significantly correlated with postoperative BNP levels (p=0.031). Receiver operating characteristic curves demonstrated postoperative BNP levels as predictors of hospital stay ${\geq}30$ days with areas under the curve of 0.774 (95% confidence interval: 0.679-0.87, p<0.0001). A BNP cut-off value above 217.5 pg/mL had a sensitivity of 80.6% and a specificity of 66.7% for predicting postoperative hospital stays of 30 days or more. Conclusion: Postoperative BNP levels may predict the length of hospital stays after non-cardiac surgery in hypertensive patients. Elevated BNP levels were associated with prolonged hospitalization after elective orthopedic surgery.

Keywords

References

  1. Eagle KA, Berger PB, Calkins H, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery: executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 2002;105:1257-67.
  2. Goldman L. Cardiac risks and complications of noncardiac surgery. Ann Intern Med 1983;98:504-13. https://doi.org/10.7326/0003-4819-98-4-504
  3. Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990; 72:153-84. https://doi.org/10.1097/00000542-199001000-00025
  4. Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977;297: 845-50. https://doi.org/10.1056/NEJM197710202971601
  5. Detsky AS, Abrams HB, Forbath N, Scott JG, Hilliard JR. Cardiac assessment for patients undergoing noncardiac surgery: a multifactorial clinical risk index. Arch Intern Med 1986;146:2131-4. https://doi.org/10.1001/archinte.1986.00360230047007
  6. Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999;100:1043-9. https://doi.org/10.1161/01.CIR.100.10.1043
  7. Poldermans D, Boersma E, Bax JJ, et al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery: Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 1999;341:1789-94. https://doi.org/10.1056/NEJM199912093412402
  8. Eagle KA, Coley CM, Newell JB, et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med 1989;110:859-66. https://doi.org/10.7326/0003-4819-110-11-859
  9. Halm EA, Browner WS, Tubau JF, Tateo IM, Mangano DT. Echocardiography for assessing cardiac risk in patients having noncardiac surgery: Study of Perioperative Ischemia Research Group. Ann Intern Med 1996;125:433-41. https://doi.org/10.7326/0003-4819-125-6-199609150-00001
  10. Auerbach A, Goldman L. Assessing and reducing the cardiac risk of noncardiac surgery. Circulation 2006;113:1361-76. https://doi.org/10.1161/CIRCULATIONAHA.105.573113
  11. McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham Study. N Engl J Med 1971; 285:1441-6. https://doi.org/10.1056/NEJM197112232852601
  12. Bettencourt P, Azevedo A, Pimenta J, Frioes F, Ferreira S, Ferreira A. Nterminal- pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients. Circulation 2004;110:2168-74. https://doi.org/10.1161/01.CIR.0000144310.04433.BE
  13. Heeschen C, Hamm CW, Mitrovic V, Lantelme NH, White HD; Platelet Receptor Inhibition in Ischemic Syndrome Management (PRISM) In vestigators. N-terminal pro-B-type natriuretic peptide levels for dynamic risk stratification of patients with acute coronary syndromes. Circulation 2004;110:3206-12. https://doi.org/10.1161/01.CIR.0000147611.92021.2B
  14. Goei D, van Kuijk JP, Flu WJ, et al. Usefulness of repeated N-terminal pro-B-type natriuretic peptide measurements as incremental predictor for long-term cardiovascular outcome after vascular surgery. Am J Cardiol 2011;107:609-14. https://doi.org/10.1016/j.amjcard.2010.10.021
  15. Schutt RC, Cevik C, Phy MP. Plasma N-terminal prohormone brain natriuretic peptide as a marker for postoperative cardiac events in highrisk patients undergoing noncardiac surgery. Am J Cardiol 2009;104: 137-40. https://doi.org/10.1016/j.amjcard.2009.03.005
  16. Goei D, Hoeks SE, Boersma E, et al. Incremental value of high-sensitivity C-reactive protein and N-terminal pro-B-type natriuretic peptide for the prediction of postoperative cardiac events in noncardiac vascular surgery patients. Coron Artery Dis 2009;20:219-24. https://doi.org/10.1097/MCA.0b013e3283219e47
  17. Cowie MR, Mendez GF. BNP and congestive heart failure. Prog Cardiovasc Dis 2002;44:293-321. https://doi.org/10.1053/pcad.2002.24599
  18. Nakagawa O, Ogawa Y, Itoh H, et al. Rapid transcriptional activation and early mRNA turnover of brain natriuretic peptide in cardiocyte hypertrophy: evidence for brain natriuretic peptide as an "emergency" cardiac hormone against ventricular overload. J Clin Invest 1995;96: 1280-7. https://doi.org/10.1172/JCI118162
  19. Kragelund C, Gronning B, Kober L, Hildebrandt P, Steffensen R. N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med 2005;352:666-75. https://doi.org/10.1056/NEJMoa042330
  20. De Lemos JA, Morrow DA, Bentley JH, et al. The prognostic value of Btype natriuretic peptide in patients with acute coronary syndromes. N Engl J Med 2001;345:1014-21. https://doi.org/10.1056/NEJMoa011053
  21. Leibowitz D, Planer D, Rott D, Elitzur Y, Chajek-Shaul T, Weiss AT. Brain natriuretic peptide levels predict perioperative events in cardiac patients undergoing noncardiac surgery: a prospective study. Cardiology 2008;110:266-70. https://doi.org/10.1159/000112411
  22. Dernellis J, Panaretou M. Assessment of cardiac risk before non-cardiac surgery: brain natriuretic peptide in 1590 patients. Heart 2006;92: 1645-50. https://doi.org/10.1136/hrt.2005.085530
  23. Berry C, Kingsmore D, Gibson S, et al. Predictive value of plasma brain natriuretic peptide for cardiac outcome after vascular surgery. Heart 2006;92:401-2.
  24. Cuthbertson BH, Amiri AR, Croal BL, et al. Utility of B-type natriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery. Br J Anaesth 2007;99:170-6. https://doi.org/10.1093/bja/aem158
  25. Cuthbertson BH, Amiri AR, Croal BL, Rajagopalan S, Brittenden J, Hillis GS. Utility of B-type natriuretic peptide in predicting medium-term mortality in patients undergoing major non-cardiac surgery. Am J Cardiol 2007;100:1310-3. https://doi.org/10.1016/j.amjcard.2007.05.058
  26. Hutfless R, Kazanegra R, Madani M, et al. Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgery. J Am Coll Cardiol 2004;43:1873-9. https://doi.org/10.1016/j.jacc.2003.12.048

Cited by

  1. Postoperative B-type Natriuretic Peptide for Prediction of Major Cardiac Events in Patients Undergoing Noncardiac Surgery: Systematic Review and Individual Patient Meta-analysis vol.119, pp.2, 2012, https://doi.org/10.1097/aln.0b013e31829083f1
  2. Restrictive Deferred Hydration Combined with Preemptive Norepinephrine Infusion during Radical Cystectomy Reduces Postoperative Complications and Hospitalization Time: A Randomized Clinical Trial vol.120, pp.2, 2012, https://doi.org/10.1097/aln.0b013e3182a44440
  3. The Effect of Anesthesia Method on Serum Level of Pro-Brain Natriuretic Peptide in Patients Undergoing Orthopedic Surgery vol.5, pp.2, 2012, https://doi.org/10.5812/aapm.19707
  4. B-type natriuretic peptide vs. cardiac risk scores for prediction of outcome following major orthopedic surgery : vol.16, pp.6, 2015, https://doi.org/10.2459/jcm.0000000000000210
  5. Sleep apnea in total joint arthroplasty patients and the role for cardiac biomarkers for risk stratification: an exploration of feasibility vol.10, pp.3, 2012, https://doi.org/10.2217/bmm.16.1
  6. Sleep apnea in total joint arthroplasty patients and the role for cardiac biomarkers for risk stratification: an exploration of feasibility vol.10, pp.3, 2012, https://doi.org/10.2217/bmm.16.1
  7. In-Hospital Postoperative Pneumonia Following Geriatric Intertrochanteric Fracture Surgery: Incidence and Risk Factors vol.15, pp.None, 2012, https://doi.org/10.2147/cia.s268118