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

Division of Cardiology, Department of Internal Medicine, Kang Nam General Hosptial, Yongin, Korea.
Korean Circulation Journal (Impact Factor: 0.75). 08/2012; 42(8):521-7. DOI: 10.4070/kcj.2012.42.8.521
Source: PubMed


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.
Ninety-seven (97) patients, aged 55 years or older (mean age: 73.12±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.
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 ≥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.
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.

Download full-text


Available from: Wook Bum Pyun, Nov 19, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: 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 < 0.001), mortality (AOR, 4.2; 95% CI, 2.29-7.69; P < 0.001), cardiac mortality (AOR, 9.4; 95% CI, 0.32-254.34; P < 0.001), and cardiac failure (AOR, 18.5; 95% CI, 4.55-75.29; P < 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 < 0.001), mortality (AOR, 2.2; 95% CI, 1.67-86; P < 0.001), cardiac mortality (AOR, 2.1; 95% CI, 0.05-1,385.17; P < 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.
    Anesthesiology 03/2013; 119(2). DOI:10.1097/ALN.0b013e31829083f1 · 5.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Anesthetics and neuraxial anesthesia commonly result in vasodilation/hypotension. Norepinephrine counteracts this effect and thus allows for decreased intraoperative hydration. The authors investigated whether this approach could result in reduced postoperative complication rate. In this single-center, double-blind, randomized, superiority trial, 166 patients undergoing radical cystectomy and urinary diversion were equally allocated to receive 1 ml·kg·h of balanced Ringer's solution until the end of cystectomy and then 3 ml·kg·h until the end of surgery combined with preemptive norepinephrine infusion at an initial rate of 2 µg·kg·h (low-volume group; n = 83) or 6 ml·kg·h of balanced Ringer's solution throughout surgery (control group; n = 83). Primary outcome was the in-hospital complication rate. Secondary outcomes were hospitalization time, and 90-day mortality. In-hospital complications occurred in 43 of 83 patients (52%) in the low-volume group and in 61 of 83 (73%) in the control group (relative risk, 0.70; 95% CI, 0.55-0.88; P = 0.006). The rates of gastrointestinal and cardiac complications were lower in the low-volume group than in the control group (5 [6%] vs. 31 [37%]; relative risk, 0.16; 95% CI, 0.07-0.39; P < 0.0001 and 17 [20%] vs. 39 [48%], relative risk, 0.43; 95% CI, 0.26-0.60; P = 0.0003, respectively). The median hospitalization time was 15 days [range, 11, 27d] in the low-volume group and 17 days [11, 95d] in the control group (P = 0.02). The 90-day mortality was 0% in the low-volume group and 4.8% in the control group (P = 0.12). A restrictive-deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy and urinary diversion significantly reduced the postoperative complication rate and hospitalization time.
    Anesthesiology 07/2013; 120(2). DOI:10.1097/ALN.0b013e3182a44440 · 5.88 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: - To determine if measuring postoperative B-type natriuretic peptides (NP, i.e., B-type natriuretic peptide [BNP] and N-terminal fragment of proBNP [NT-proBNP]) enhances risk stratification, in adult patients undergoing noncardiac surgery, in whom a preoperative NP has been measured. - Preoperative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated postoperative NP concentrations are independently associated with these complications. It is not clear if there is value in measuring postoperative NP when a preoperative measurement has been done. We conducted a systematic review and individual patient data meta-analysis to determine if the addition of postoperative NP enhanced the prediction of the composite of death and nonfatal myocardial infarction (MI) at 30 and ≥180 days after surgery. 18 eligible studies provided individual patient data (n=2179). Adding postoperative NP to a risk prediction model containing preoperative NP improved model fit and risk classification at both 30 days (QICu 1280 to 1204; NRI 20%; p<0.001) and at ≥180 days (QICu 1320 to 1300; NRI 11%; p=0.003). Elevated postoperative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio [OR] 3.7; 95% CI 2.2-6.2; p<0.001) and ≥180 days (OR 2.2; 95% CI 1.9-2.7; p<0.001) after surgery. Additional postoperative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal MI 30 days and ≥180 days after noncardiac surgery as compared to a preoperative NP measurement alone.a.
    Journal of the American College of Cardiology 09/2013; 63(2). DOI:10.1016/j.jacc.2013.08.1630 · 16.50 Impact Factor
Show more