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 Rajagopalan; Milan Radovic'; Robert C. Schutt; Daniel I. Sessler; S. Suttie; Thuvaraha Vanniyasingam; Marek Waliszek; P.J. Devereaux

doi:10.1097/ALN.0b013e31829083f1

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 Rajagopalan

Milan Radovic', Robert C. Schutt, Daniel I. Sessler, S. Suttie, Thuvaraha Vanniyasingam, Marek Waliszek, P.J. Devereaux

Research output: Contribution to journal › Article › peer-review

100 Citations (Scopus)

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 language	English
Pages (from-to)	271-283
Number of pages	13
Journal	ANESTHESIOLOGY
Volume	119
Issue number	2
DOIs	https://doi.org/10.1097/ALN.0b013e31829083f1
Publication status	Published - 2013

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10.1097/ALN.0b013e31829083f1

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Rodseth, R., Biccard, B., Chu, R., Lurati Buse, G. A., Thabane, L., Bakhai, A., Bolliger, D., Cagini, L., Cahill, T., Cardinale, D., Chong, C. P., Cnotliwy, M., Di Somma, S., Fahrner, R., Lim, W. K., Mahla, E., Le Manach, Y., Manikandan, R., Pyun, W. B., ... Devereaux, P. J. (2013). Postoperative B-type natriuretic peptide for prediction of major cardiac events in patients undergoing noncardiac surgery: systematic review and individual patient meta-analysis. ANESTHESIOLOGY, 119(2), 271-283. https://doi.org/10.1097/ALN.0b013e31829083f1

@article{23e42efb9ba24587bf62c7c2293553bf,

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

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.",

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

year = "2013",

doi = "10.1097/ALN.0b013e31829083f1",

language = "English",

volume = "119",

pages = "271--283",

journal = "ANESTHESIOLOGY",

issn = "0003-3022",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

Rodseth, R, Biccard, B, Chu, R, Lurati Buse, GA, Thabane, L, Bakhai, A, Bolliger, D, Cagini, L, Cahill, T, Cardinale, D, Chong, CP, Cnotliwy, M, Di Somma, S, Fahrner, R, Lim, WK, Mahla, E, Le Manach, Y, Manikandan, R, Pyun, WB, Rajagopalan, S, Radovic', M, Schutt, RC, Sessler, DI, Suttie, S, Vanniyasingam, T, Waliszek, M & Devereaux, PJ 2013, 'Postoperative B-type natriuretic peptide for prediction of major cardiac events in patients undergoing noncardiac surgery: systematic review and individual patient meta-analysis', ANESTHESIOLOGY, vol. 119, no. 2, pp. 271-283. https://doi.org/10.1097/ALN.0b013e31829083f1

TY - JOUR

T1 - Postoperative B-type natriuretic peptide for prediction of major cardiac events in patients undergoing noncardiac surgery

T2 - systematic review and individual patient meta-analysis

AU - Rodseth, Reitze

AU - Biccard, Bruce

AU - Chu, Rong

AU - Lurati Buse, Giovana A.

AU - Thabane, Lehana

AU - Bakhai, Ameet

AU - Bolliger, Daniel

AU - Cagini, Lucio

AU - Cahill, Thomas

AU - Cardinale, Daniela

AU - Chong, Carol P.

AU - Cnotliwy, Miloslaw

AU - Di Somma, Salvatore

AU - Fahrner, Rene

AU - Lim, Wen K.

AU - Mahla, Elisabeth

AU - Le Manach, Yannick

AU - Manikandan, Ramaswany

AU - Pyun, Wook B.

AU - Rajagopalan, Sriram

AU - Radovic', Milan

AU - Schutt, Robert C.

AU - Sessler, Daniel I.

AU - Suttie, S.

AU - Vanniyasingam, Thuvaraha

AU - Waliszek, Marek

AU - Devereaux, P.J.

PY - 2013

Y1 - 2013

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/84880924940

U2 - 10.1097/ALN.0b013e31829083f1

DO - 10.1097/ALN.0b013e31829083f1

M3 - Article

C2 - 23528538

AN - SCOPUS:84880924940

SN - 0003-3022

VL - 119

SP - 271

EP - 283

JO - ANESTHESIOLOGY

JF - ANESTHESIOLOGY

IS - 2

ER -

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

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