| Title: |
The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery. B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide. a systematic review and individual patient data meta-analysis |
| Authors: |
Rodseth RN; Biccard BM; Le Manach Y; Sessler DI; Lurati Buse GA; Thabane L; Schutt RC; Bolliger D; Cagini L; Cardinale D; Chong CP; Chu R; Cnotliwy M; DI SOMMA, Salvatore; Fahrner R; Lim WK; Mahla E; Manikandan R; Puma F; Pyun WB; Radović M; Rajagopalan S; Suttie S; Vanniyasingam T; van Gaal WJ; Waliszek M; Devereaux PJ |
| Contributors: |
Rodseth, Rn; Biccard, Bm; Le Manach, Y; Sessler, Di; Lurati Buse, Ga; Thabane, L; Schutt, Rc; Bolliger, D; Cagini, L; Cardinale, D; Chong, Cp; Chu, R; Cnotliwy, M; DI SOMMA, Salvatore; Fahrner, R; Lim, Wk; Mahla, E; Manikandan, R; Puma, F; Pyun, Wb; Radović, M; Rajagopalan, S; Suttie, S; Vanniyasingam, T; van Gaal, Wj; Waliszek, M; Devereaux, Pj |
| Publisher Information: |
Elsevier Inc. |
| Publication Year: |
2014 |
| Collection: |
Sapienza Università di Roma: CINECA IRIS |
| Subject Terms: |
b-type natriuretic peptide; bnp; revised cardiac risk index; anesthesia |
| Description: |
OBJECTIVES: The objective of this study was to determine whether measuring post-operative B-type natriuretic peptides (NPs) (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 pre-operative NP has been measured. BACKGROUND: Pre-operative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated post-operative NP concentrations are independently associated with these complications. It is not clear whether there is value in measuring post-operative NP when a pre-operative measurement has been done. METHODS: We conducted a systematic review and individual patient data meta-analysis to determine whether the addition of post-operative NP levels enhanced the prediction of the composite of death and nonfatal myocardial infarction at 30 and ≥180 days after surgery. RESULTS: Eighteen eligible studies provided individual patient data (n = 2,179). Adding post-operative NP to a risk prediction model containing pre-operative NP improved model fit and risk classification at both 30 days (corrected quasi-likelihood under the independence model criterion: 1,280 to 1,204; net reclassification index: 20%; p < 0.001) and ≥180 days (corrected quasi-likelihood under the independence model criterion: 1,320 to 1,300; net reclassification index: 11%; p = 0.003). Elevated post-operative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio: 3.7; 95% confidence interval: 2.2 to 6.2; p < 0.001) and ≥180 days (odds ratio: 2.2; 95% confidence interval: 1.9 to 2.7; p < 0.001) after surgery. CONCLUSIONS: Additional post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and ≥180 days after noncardiac surgery compared with a pre-operative NP measurement alone. |
| Document Type: |
article in journal/newspaper |
| File Description: |
STAMPA |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/24076282; info:eu-repo/semantics/altIdentifier/wos/WOS:000329839200012; volume:63; issue:2; firstpage:170; lastpage:180; numberofpages:11; journal:JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY; http://hdl.handle.net/11573/625134; http://www.sciencedirect.com/science/article/pii/S0735109713053527# |
| DOI: |
10.1016/j.jacc.2013.08.1630 |
| Availability: |
http://hdl.handle.net/11573/625134; https://doi.org/10.1016/j.jacc.2013.08.1630; http://www.sciencedirect.com/science/article/pii/S0735109713053527# |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.29CF99AD |
| Database: |
BASE |