Key result
Preoperative BNP levels >190 pg/ml predicted ICU stay >5 days (AUC 0.712) and levels >20.5 pg/ml correlated with dobutamine use (AUC 0.842) after cardiac surgery.
Why the study?
Do preoperative BNP and inflammatory markers predict adverse immediate outcomes in patients undergoing cardiac surgery with cardiopulmonary bypass?
Observational (n=62)
Do preoperative BNP and inflammatory markers predict adverse immediate outcomes in patients undergoing cardiac surgery with cardiopulmonary bypass?
Effect estimate: AUC 0.712 for ICU >5 days; AUC 0.842 for dobutamine use
p-value: p=0.003 for ICU stay; <0.001 for dobutamine use
Preoperative BNP is a stronger predictor of early adverse clinical outcomes and resource utilization after cardiac surgery than inflammatory markers.
Preoperative BNP may stratify risk for prolonged ICU stay and inotrope need after cardiac surgery; hypothesis-generating pending prospective validation.
OBJECTIVES: B-type natriuretic peptide (BNP) and inflammatory markers are implicated in the pathophysiology of both ischemic cardiomyopathy and complications after cardiac surgery with cardiopulmonary bypass (CPB). The purpose of this study was to assess preoperative and postoperative levels of BNP, interleukin-6 (IL-6), interleukin-8 (IL-8), P-selectin, intercellular adhesion molecule (ICAM), C-reactive protein (CRP) in patients undergoing cardiac surgery with CPB and investigate their variation and ability to correlate with immediate outcome. METHODS: Plasma levels of these markers were measured preoperatively, 6 and 24 h after CBP in 62 patients. Main endpoints were requirements for intra-aortic balloon pump, intensive care unit (ICU) stay longer than five days, ventilator dependence >24 h, requirement for dobutamine, hospital stay >10 days, clinical complications (infection, myocardial infarction, renal failure, stroke and ventricular arrhythmias) and in-hospital mortality. RESULTS: Preoperative BNP levels correlate with longer ICU stay (P = 0.003), longer ventilator use (P = 0.018) and duration of dobutamine use (P < 0.001). The receiver-operating characteristic curve demonstrated BNP levels >190 pg/ml as predictor of ICU >5 days and BNP levels >20.5 pg/ml correlated with dobutamine use, with areas under the curve of 0.712 and 0.842, respectively. Preoperative levels of ICAM-1 were associated with in-hospital mortality (P = 0.042). In the postoperative period, was found association between CRP, IL-6 and P-selectin with ventilation duration (P = 0.013, P = 0.006, P < 0.001, respectively) and P-selectin with ICU stay (P = 0.009). CONCLUSIONS: BNP correlates with clinical endpoints more than inflammatory markers and can be used as a predictor of early outcome after heart surgery.
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Ganem et al. (2011) conducted an observational in Cardiac surgery with cardiopulmonary bypass (n=62). Preoperative B-type natriuretic peptide (BNP) was evaluated on Immediate outcome including ICU stay >5 days, ventilator dependence >24 h, dobutamine use, clinical complications, and in-hospital mortality (AUC 0.712 for ICU >5 days; AUC 0.842 for dobutamine use, p=0.003 for ICU stay; <0.001 for dobutamine use). Preoperative BNP levels >190 pg/ml predicted ICU stay >5 days (AUC 0.712) and levels >20.5 pg/ml correlated with dobutamine use (AUC 0.842) after cardiac surgery.
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