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Postoperative Increase in B-Type Natriuretic Peptide Levels Predicts Adverse Outcome After Cardiac Surgery.

Nozohoor, Shahab LU ; Nilsson, Johan LU ; Algotsson, Lars LU and Sjögren, Johan LU (2011) In Journal of Cardiothoracic and Vascular Anesthesia Okt. p.469-475
Abstract
OBJECTIVE:: To evaluate the prognostic implication of changes in postoperative B-type natriuretic peptide (BNP) concentrations in patients undergoing cardiopulmonary bypass for cardiac surgery. DESIGN:: A retrospective analysis of prospectively collected clinical data. SETTING:: Cardiothoracic surgery and an intensive care unit (ICU) in a university hospital. PARTICIPANTS:: The present study included a total of 407 consecutive patients undergoing cardiac surgery. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: BNP concentrations were measured on admittance to the ICU (D0) and at day 1 after surgery. Patients were divided into quintiles according to their BNP level on admittance to the ICU. The predictive value of absolute changes in... (More)
OBJECTIVE:: To evaluate the prognostic implication of changes in postoperative B-type natriuretic peptide (BNP) concentrations in patients undergoing cardiopulmonary bypass for cardiac surgery. DESIGN:: A retrospective analysis of prospectively collected clinical data. SETTING:: Cardiothoracic surgery and an intensive care unit (ICU) in a university hospital. PARTICIPANTS:: The present study included a total of 407 consecutive patients undergoing cardiac surgery. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: BNP concentrations were measured on admittance to the ICU (D0) and at day 1 after surgery. Patients were divided into quintiles according to their BNP level on admittance to the ICU. The predictive value of absolute changes in BNP levels during the first 24 hours postoperatively was analyzed with Kaplan-Meier estimates of survival and Cox multivariate proportional analysis. Prognostic factors for impaired midterm survival included elevation of the BNP level (HR, 7.3/ log10(x); 95% confidence interval, 1.8-29, p = 0.005). The BNP levels of patients undergoing isolated valve surgery or valve and concomitant CABG surgery were significantly higher (p = 0.012 and p = 0.032, respectively) than those undergoing isolated coronary artery bypass graft surgery. Patients in higher quintiles required ventilation for a longer time (p < 0.001), and prolonged inotropic support (p < 0.001). The mean plasma BNP concentration of 172 pg/mL (median, 64; interquartile range, 172) on arrival at the ICU had a sensitivity of 75% and a specificity of 74% for predicting 1-year mortality. CONCLUSIONS:: Elevated BNP levels on admittance to the ICU and postoperatively increasing BNP levels are associated with adverse postoperative outcome and are predictive of impaired late survival. Sequential postoperative BNP monitoring facilitates the early identification of patients at an increased risk of heart failure and may be used as an adjunct for clinical decision making and optimized patient management. (Less)
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author
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type
Contribution to journal
publication status
published
subject
in
Journal of Cardiothoracic and Vascular Anesthesia
volume
Okt
pages
469 - 475
publisher
W B Saunders
external identifiers
  • wos:000291412000014
  • pmid:20829070
  • scopus:79957691615
ISSN
1532-8422
DOI
10.1053/j.jvca.2010.07.002
language
English
LU publication?
yes
id
ffb0273c-ac58-4a9a-98e4-fc8715ec8384 (old id 1688325)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/20829070?dopt=Abstract
date added to LUP
2010-10-05 09:58:41
date last changed
2017-11-12 04:07:50
@article{ffb0273c-ac58-4a9a-98e4-fc8715ec8384,
  abstract     = {OBJECTIVE:: To evaluate the prognostic implication of changes in postoperative B-type natriuretic peptide (BNP) concentrations in patients undergoing cardiopulmonary bypass for cardiac surgery. DESIGN:: A retrospective analysis of prospectively collected clinical data. SETTING:: Cardiothoracic surgery and an intensive care unit (ICU) in a university hospital. PARTICIPANTS:: The present study included a total of 407 consecutive patients undergoing cardiac surgery. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: BNP concentrations were measured on admittance to the ICU (D0) and at day 1 after surgery. Patients were divided into quintiles according to their BNP level on admittance to the ICU. The predictive value of absolute changes in BNP levels during the first 24 hours postoperatively was analyzed with Kaplan-Meier estimates of survival and Cox multivariate proportional analysis. Prognostic factors for impaired midterm survival included elevation of the BNP level (HR, 7.3/ log10(x); 95% confidence interval, 1.8-29, p = 0.005). The BNP levels of patients undergoing isolated valve surgery or valve and concomitant CABG surgery were significantly higher (p = 0.012 and p = 0.032, respectively) than those undergoing isolated coronary artery bypass graft surgery. Patients in higher quintiles required ventilation for a longer time (p &lt; 0.001), and prolonged inotropic support (p &lt; 0.001). The mean plasma BNP concentration of 172 pg/mL (median, 64; interquartile range, 172) on arrival at the ICU had a sensitivity of 75% and a specificity of 74% for predicting 1-year mortality. CONCLUSIONS:: Elevated BNP levels on admittance to the ICU and postoperatively increasing BNP levels are associated with adverse postoperative outcome and are predictive of impaired late survival. Sequential postoperative BNP monitoring facilitates the early identification of patients at an increased risk of heart failure and may be used as an adjunct for clinical decision making and optimized patient management.},
  author       = {Nozohoor, Shahab and Nilsson, Johan and Algotsson, Lars and Sjögren, Johan},
  issn         = {1532-8422},
  language     = {eng},
  pages        = {469--475},
  publisher    = {W B Saunders},
  series       = {Journal of Cardiothoracic and Vascular Anesthesia},
  title        = {Postoperative Increase in B-Type Natriuretic Peptide Levels Predicts Adverse Outcome After Cardiac Surgery.},
  url          = {http://dx.doi.org/10.1053/j.jvca.2010.07.002},
  volume       = {Okt},
  year         = {2011},
}