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

Title
Postoperative B-type natriuretic peptide for prediction of major cardiac events in patients undergoing noncardiac surgery: Systematic review and individual patient meta-analysis
Authors
Rodseth R.N.Biccard B.M.Chu R.Lurati Buse G.A.Thabane L.Bakhai A.Bolliger D.Cagini L.Cahill T.J.Cardinale D.Chong C.P.W.Cnotliwy M.Di Somma S.Fahrner R.Lim W.K.Mahla E.Le Manach Y.Manikandan R.Pyun W.B.Rajagopalan S.Radovic&aposM.Schutt R.C.Sessler D.I.Suttie S.Vanniyasingam T.Waliszek M.Devereaux P.J.
Ewha Authors
편욱범
SCOPUS Author ID
편욱범scopus
Issue Date
2013
Journal Title
Anesthesiology
ISSN
0003-3022JCR Link
Citation
vol. 119, no. 2, pp. 271 - 283
Indexed
SCI; SCIE; SCOPUS 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. Copyright © 2013, the American Society of Anesthesiologists, Inc. Lippincott Williams &Wilkins.
DOI
10.1097/ALN.0b013e31829083f1
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의학전문대학원 > 의학과 > Journal papers
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