MiscellaneousUsefulness of N-Terminal Pro–Brain Natriuretic Peptide to Predict Postoperative Cardiac Complications and Long-Term Mortality After Emergency Lower Limb Orthopedic Surgery
Section snippets
Methods
This prospective observational study recruited 119 consecutive patients from the orthopedic–geriatric unit from the Northern Hospital (Epping, Victoria, Australia) from April to December 2006. Ethics approval was given by the institutions human research and ethics committee and written informed consent was obtained for each patient. Patients were included if they were >60 years of age and underwent emergency orthopedic surgery for fractures or acute orthopedic conditions such as septic
Results
Eighty-nine patients (mean ± SD 79 ± 10 years of age) were included in this study, and 27 of 102 (26%) studied were men. Table 1 lists patient characteristics. Twenty-seven patients were excluded because 10 had operations affecting the upper limb, 7 did not have stored blood, 2 did not have surgery, 5 declined participation, 1 died preoperatively, and 2 withdrew. Main forms of surgery were internal fixation of fractures, hemiarthroplasties, and general anesthetic and manipulation of plaster.
Discussion
This study demonstrated that pre- and postoperative NT–pro-BNP levels in an emergency orthopedic–geriatric population were associated with increased risk of in-hospital cardiac complications and increased 1- and 2-year mortality. Using ROC curves, we found that preoperative NT–pro-BNP ≥842 pg/ml or postoperative NT–pro-BNP ≥1,401 pg/ml best predicted in-hospital cardiac complications and longer-term mortality. Multivariate analysis showed that NT–pro-BNP was an independent predictor of these
Acknowledgment
Our thanks to Austin Pathology for measuring plasma NT–pro-BNP and to Abbott Diagnostics and Austin Pathology for complimentary testing of troponin I.
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Cited by (31)
Predictive value of B-type natriuretic peptide (BNP) for adverse cardiac events in patients undergoing primary total knee arthroplasty (TKA)
2016, Journal of Orthopaedic ScienceCitation Excerpt :Several well-designed studies have examined its predictive role [7–10]. However, their results have a certain limitations, as a lack of homogeneity results from BNP which was sampled from patients who underwent different orthopedic procedures including femur fracture, hip or knee arthroplasty [7–10]. We know TKA procedure is distinguished from other orthopedic procedures due to advanced age, applications of bone cement, tourniquet, and anticoagulants and so on [11].
The use of preoperative B-type natriuretic peptide as a predictor of atrial fibrillation after thoracic surgery: Systematic review and meta-analysis
2015, Journal of Cardiothoracic and Vascular AnesthesiaPredictive value of plasma brain natriuretic peptide for postoperative cardiac complications-A systemic review and meta-analysis
2014, Journal of Critical CareCitation Excerpt :Systemic physiologic effects of natriuretic peptides (NPs) include natriuresis, diuresis, and vasodilation [4]. Several studies have shown its ability to predict perioperative major adverse cardiovascular events (MACE) including atrial or ventricular arrhythmia, myocardial infarction, or sudden cardiac death [5–31]. Several meta-analyses have demonstrated that increased NT-proBNP levels predict short- and longer term cardiac complications [4,32,33].
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
2014, Journal of the American College of Cardiology
This study was sponsored by a Cardiovascular Lipid grant from Pfizer, Australia. Dr. Chong is a recipient of an National Health and Medical Research Council (Australia) postgraduate research scholarship and has received research stipends from the University of Melbourne, Melbourne, Victoria, Australia, and the Northern Clinical Research Centre, Northern Health, Melbourne.