Postoperative B-type natriuretic peptide for prediction of major cardiac events in patients undergoing noncardiac surgery: systematic review and individual patient meta-analysis

Reitze Rodseth, Bruce Biccard, Rong Chu, Giovana A. Lurati Buse, Lehana Thabane, Ameet Bakhai, Daniel Bolliger, Lucio Cagini, Thomas Cahill, Daniela Cardinale, Carol P. Chong, Miloslaw Cnotliwy, Salvatore Di Somma, Rene Fahrner, Wen K. Lim, Elisabeth Mahla, Yannick Le Manach, Ramaswany Manikandan, Wook B. Pyun, Sriram RajagopalanMilan Radovic', Robert C. Schutt, Daniel I. Sessler, S. Suttie, Thuvaraha Vanniyasingam, Marek Waliszek, P.J. Devereaux

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    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.
    Original languageEnglish
    Pages (from-to)271-283
    Number of pages13
    JournalANESTHESIOLOGY
    Volume119
    Issue number2
    DOIs
    Publication statusPublished - 2013

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