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.
J Am Coll Cardiol
; 63(2): 170-80, 2014 Jan 21.
Article
em En
| MEDLINE
| ID: mdl-24076282
ABSTRACT
OBJECTIVES:
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.BACKGROUND:
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.METHODS:
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.RESULTS:
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.CONCLUSIONS:
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.Palavras-chave
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
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Procedimentos Cirúrgicos Operatórios
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Doenças Cardiovasculares
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Peptídeo Natriurético Encefálico
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Prognostic_studies
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Risk_factors_studies
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Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
J Am Coll Cardiol
Ano de publicação:
2014
Tipo de documento:
Article
País de afiliação:
Chile