Preoperative and peak postoperative NT-proBNP independently predicted 30-day mortality (aHR 1.9) and pAHF (aHR 2.4) with AUC up to 0.89 after major non-cardiac surgery.
Do serial measurements of NT-proBNP predict 30-day mortality and postoperative acute heart failure in high-cardiac-risk patients undergoing non-cardiac surgery?
Preoperative and peak postoperative NT-proBNP levels are independently associated with 30-day mortality and postoperative acute heart failure in high-risk patients undergoing non-cardiac surgery.
Absolute Event Rate: 0% vs 0%
Abstract Background Although perioperative NT-proBNP elevations have been associated with mortality, the prognostic significance of its perioperative kinetics remains unclear. Purpose To evaluate perioperative NT-proBNP kinetics before and after non-cardiac surgery and assess its association with 30-day mortality and postoperative acute heart failure (pAHF). Methods We prospectively measured NT-proBNP concentrations preoperatively and on postoperative days 1 (1PO) and 2 (2PO) in consecutive high-cardiac-risk patients undergoing inpatient non-cardiac surgery. Non-parametric tests were used to assess the distribution of NT-proBNP, while Cox regression models evaluated the association between peak pre- and postoperative NT-proBNP concentrations and 30-day mortality as well as pAHF. Receiver operating characteristic curves were constructed to determine the predictive value of NT-proBNP concentrations. Results Among 1,759 patients, 45 (3%) died, and 70 (4%) developed pAHF within 30 days. NT-proBNP levels significantly increased postoperatively (preoperative median 277 ng/L IQR 120–867 ng/L; 1PO: 432 ng/L IQR 200–1053 ng/L; 2PO: 567 ng/L IQR 238–1355 ng/L; p0.001). In 10% of patients there was a decrease in NT-proBNP levels. Median NT-ProBNP concentrations in all time points were higher in patients who died or developed pAHF than in patients without these outcomes (p0.001; Figure). Preoperative and peak postoperative NT-proBNP were independent predictors of mortality (adjusted hazard ratio aHR 1.3 95% CI, 1.0–1.7, p=0.031 and aHR 1.9 95% CI, 1.5–2.5, p0.001, respectively) and pAHF (aHR 1.7 95% CI, 1.4–2.1 and aHR 2.4 95% CI, 2.0–2.9, p0.001, respectively). Preoperative and peak postoperative NT-proBNP concentrations showed good accuracy for prediction of mortality (area under the curve AUC 0.79 and 0.81, respectively; p=0.21), and pAHF (AUC 0.83 and 0.89, respectively; p=0.012). Conclusion NT-proBNP concentrations increase postoperatively in most patients. Preoperative and peak postoperative NT-proBNP levels were independently associated to 30-day mortality and pAHF.
Gualandro et al. (Sat,) reported a other. Preoperative and peak postoperative NT-proBNP independently predicted 30-day mortality (aHR 1.9) and pAHF (aHR 2.4) with AUC up to 0.89 after major non-cardiac surgery.