Predictors of mortality in cardiac surgery: brain natriuretic peptide type B

Jamil Alli Murad Junior, Marcelo Arruda Nakazone, Mauricio de Nassau Machado, Moacir Fernandes de Godoy, Jamil Alli Murad Junior, Marcelo Arruda Nakazone, Mauricio de Nassau Machado, Moacir Fernandes de Godoy

Abstract

Objective: We evaluated whether the preoperative serum concentration of brain natriuretic peptide (BNP) is a predictor of in-hospital mortality in patients that underwent cardiac surgery.

Methods: We continuously evaluated 488 patients that underwent cardiac valve surgery or coronary artery bypass grafting (CABG) between January of 2009 and July of 2012. Follow up of these patients were done prospectively for 30 days postoperatively.

Results: Data analysis showed that the overall mortality rate was equal to 9.6%, Receiver Operating Charactheristic (ROC) curve analysis found the optimal cut-off value of BNP equal to 382 pg/mL for overall mortality (AUC=0.73, 95% CI=0.66 to 0.81, P<0.001). Multivariate analysis showed that the value of BNP higher than 382 pg/mL (P=0.033, HR=2.05, 95% CI=1.6 to 3.98) was an independent predictor of overall mortality at 30 days postoperatively.

Conclusion: We concluded that the preoperative serum concentration of BNP is an independent predictor of mortality in patients undergoing valve surgery or coronary artery bypass graft.

Figures

Fig. 1
Fig. 1
ROC (Receiver Operating Characteristic) curve relating preoperative serum brain natriuretic peptide (BNP) and mortality from all causes.
Fig. 2
Fig. 2
Kaplan-Meier’s curve for survival at 30 days postoperatively. BNP=brain natriuretc peptide

References

    1. Litton E, Ho KM. The use of pre-operative brain natriuretic peptides as a predictor of adverse outcomes after cardiac surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2012;41(3):525–534.
    1. Patel UD, Garg AX, Krumholz HM, Shlipak MG, Coca SG, Sint K, et al. Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) Consortium Preoperative serum brain natriuretic peptide and risk of acute kidney injury after cardiac surgery. Circulation. 2012;125(11):1347–1355.
    1. Mitchell J, Webb ST. Is brain natriuretic peptide marker for adverse postoperative outcomes in patients undergoing cardiac surgery. Interact Cardiovasc Thorac Surg. 2011;12(3):467–472.
    1. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE) Eur J Cardiothorac Surg. 1999;16(1):9–13.
    1. Geissler HJ, Hölzl P, Marohl S, Kuhn-Régnier F, Mehlhorn U, Südkamp M, et al. Risk stratification in heart surgery: comparison of six score systems. Eur J Cardiothorac Surg. 2000;17(4):400–406.
    1. Struthers AD. Ten years of natriuretic peptide research: a new dawn for their diagnostic and therapeutic use? BMJ. 1994;308(6944):1615–1619.
    1. Suzuki S, Yoshimura M, Nakayama M, Mizuno Y, Harada E, Ito T, et al. Plasma level of B-type natriuretic peptide prognostic marker after the acute myocardial infarction: a long-term follow-up analysis. Circulation. 2004;110(11):1387–1391.
    1. Hartmann F, Packer M, Coats AJ, Fowler MB, Krum H, Mohacsi P, Rouleau JL, et al. Prognostic impact of plasma N-terminal pro-brain natriuretic peptide in severe chronic congestive heart failure: a substudy of the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial. Circulation. 2004;110(13):1780–1786.
    1. Fellahi JL, Daccache G, Rubes D, Massetti M, Gerard JL, Hanouz JL. Does preoperative B-type natriuretic peptide better predict adverse outcome and prolonged length of stay than the standard European System for Cardiac Operative Risk Evaluation after cardiac surgery. J Cardiothorac Vasc Anesth. 2011;25(2):256–262.
    1. Daniels LB, Maisel AS. Natriuretic peptides. J Am Coll Cardiol. 2007;50(25):2357–2368.
    1. Yasue H, Yoshimura M, Sumida H, Kikuta K, Kugiyama K, Jougasaki M, et al. Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation. 1994;90(1):195–203.
    1. Sudoh T, Kangawa K, Minamino N, Matsuo H. A new natriuretic peptide in porcine brain. Nature. 1988;332(6159):78–81.
    1. Ferreira CA, Vicente WV, Evora PR, Rodrigues AJ, Klamt JG, Carlotti AP, et al. High-dose aprotinin does not affect troponin I, N-Terminal pro-B-type natriuretic peptide and renal function in children submitted to surgical correction with extracorporeal circulation. Rev Bras Cir Cardiovasc. 2009;24(4):519–532.
    1. Gabriel EA, Locali RF, Matsuoka PK, Almeida LS, Silva PS, Ishigai MM, et al. Pulmonary artery perfusion does not improve brain natriuretic peptide (BNP) levels in suine experimental research. Rev Bras Cardiovasc. 2010;25(4):516–526.
    1. Mukoyama M, Naka K, Hosoda K, Suga S, Saito Y, Ogawa Y, et al. Brain natriuretic peptide as a novel cardiac hormone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J Clin Invest. 1991;87(4):1402–1412.
    1. Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G. Risk of assessing mortality risk in elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony. Circulation. 2009;119(24):3053–3061.
    1. Parsonnet V, Dean D, Bernstein AD. The method of uniform stratification of risk factors for evaluating the results of surgery in acquired adult heart disease. Pt 2Circulation. 1989;79(6):I3–12.
    1. Tu JV, Sykora K, Naylor CD. Assessing the outcomes of coronary artery bypass graft surgery: how many risk factors are enough? Steering Committee of the Cardiac Care Network of Ontario. J Am Coll Cardiol. 1997;30(5):1317–1323.
    1. Maisel A, Mueller C, Adams K, Jr, Anker SD, Aspromonte N, Cleland JG, et al. State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail. 2008;10(9):824–839.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi