Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/11889
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.
Austin Authors: Rodseth, Reitze N;Biccard, Bruce M;Le Manach, Yannick;Sessler, Daniel I;Lurati Buse, Giovana A;Thabane, Lehana;Schutt, Robert C;Bolliger, Daniel;Cagini, Lucio;Cardinale, Daniela;Chong, Carol P W;Chu, Rong;Cnotliwy, Miłosław;Di Somma, Salvatore;Fahrner, René;Lim, Wen Kwang;Mahla, Elisabeth;Manikandan, Ramaswamy;Puma, Francesco;Pyun, Wook B;Radović, Milan;Rajagopalan, Sriram;Suttie, Stuart;Vanniyasingam, Thuvaraha;van Gaal, William J;Waliszek, Marek;Devereaux, P J
Affiliation: Departments of Medicine, Clinical Epidemiology, and Biostatistics, Hamilton Health Sciences, Hamilton, Ontario, Canada
Departments of Anesthesia, Clinical Epidemiology, and Biostatistics, Hamilton Health Sciences, Hamilton, Ontario, Canada
Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Biostatistics Unit, St. Joseph's Healthcare, Hamilton, Ontario, Canada
Perioperative Research Group, Department of Anaesthetics, Grey's Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa
Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
Departments of Clinical Epidemiology and Biostatistics/Anesthesia/Pediatrics, McMaster University, Hamilton, Ontario, Canada
Departments of Aged Care, Northern Clinical Research Centre, The Northern Hospital, Epping, Victoria, Australia
Department of Medicine, Northern Health, The University of Melbourne, Melbourne, Victoria, Australia
Perioperative Research Group, Department of Anaesthetics, Grey's Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.
Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
Department of Internal Medicine, University of Virginia, Charlottesville, Virginia
Department of Surgical Science, University of Perugia, Ospedale S. Maria, Perugia, Italy
Cardioncology Unit, European Institute of Oncology, Milan, Italy
Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
Department of Vascular and General Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland
Department of Medical-Surgery Sciences and Translational Medicine, University La Sapienza, and Emergency Department, Sant'Andrea Hospital, Rome, Italy
Division of General, Visceral and Vascular Surgery, University Hospital, Jena, Germany
Department of Anesthesia and Intensive Care Medicine, Medical University of Graz, Graz, Austria
Departments of Urology, Stepping Hill Hospital, Stockport, United Kingdom, and Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
Division of Cardiology, Department of Internal Medicine, Ewha Womans University, School of Medicine, Mokdong Hospital, Seoul, Korea
Clinic of Nephrology, University of Belgrade, School of Medicine, Belgrade, Serbia
Department of Vascular Surgery, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom
Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, United Kingdom
Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada
Department of Cardiology, University of Melbourne, Northern Health, Epping, Victoria, Australia
Cardiac Diagnostics Unit, M. Pirogow Provincial Specialist Hospital, Lodz, Poland
Issue Date: 26-Sep-2013
Publication information: Journal of the American College of Cardiology 2013; 63(2): 170-80
Abstract: 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.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.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.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.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.
Gov't Doc #: 24076282
URI: https://ahro.austin.org.au/austinjspui/handle/1/11889
DOI: 10.1016/j.jacc.2013.08.1630
Journal: Journal of the American College of Cardiology
URL: https://pubmed.ncbi.nlm.nih.gov/24076282
Type: Journal Article
Subjects: AUC
B-type natriuretic peptide
BNP
CI
IQR
MI
N-terminal fragment of B-type natriuretic peptide
NP
NRI
NT-proBNP
OR
QICu
RCRI
ROC
Revised Cardiac Risk Index
anesthesia
area under the curve
confidence interval
corrected quasi-likelihood under the independence model criterion
interquartile range
myocardial infarction
natriuretic peptide
natriuretic peptides
net reclassification index
odds ratio
receiver operating characteristic
risk factors
surgery
Biological Markers.blood
Cardiovascular Diseases.blood.epidemiology.etiology
Global Health
Humans
Incidence
Natriuretic Peptide, Brain.blood
Peptide Fragments.blood
Postoperative Complications.blood.epidemiology.etiology
Postoperative Period
Preoperative Period
Prognosis
Surgical Procedures, Operative
Appears in Collections:Journal articles

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