• Bing-Cheng Zhao, Pei-Pei Zhuang, Shao-Hui Lei, Shi-Da Qiu, Xiao Yang, Cai Li, Wei-Feng Liu, and Ke-Xuan Liu.
• From the Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China (B-CZ, P-PZ, S-HL, S-DQ, XY, CL, W-FL, K-XL).
• Eur J Anaesthesiol. 2021 Jun 1; 38 (6): 591-599.

BackgroundAcute kidney injury (AKI) is associated with poor outcomes after noncardiac surgery. Whether pre-operative N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts AKI after noncardiac surgery is unclear.ObjectiveTo investigate the predictive role of pre-operative NT-proBNP on postoperative AKI.DesignRetrospective cohort study.SettingNanfang Hospital, Southern Medical University, China.PatientsAdult patients who had a serum creatinine and NT-proBNP measurement within 30 pre-operative days and at least one serum creatinine measurement within 7 days after noncardiac surgery between February 2008 and May 2018 were identified.Main Outcome MeasuresThe primary outcome was postoperative AKI, defined by the kidney disease: improving global outcomes creatinine criteria.ResultsIn all, 6.1% (444 of 7248) of patients developed AKI within 1 week after surgery. Pre-operative NT-proBNP was an independent predictor of AKI after adjustment for clinical variables (OR comparing top to bottom quintiles 2.29, 95% CI, 1.47 to 3.65, P < 0.001 for trend; OR per 1-unit increment in natural log transformed NT-proBNP 1.27, 95% CI, 1.16 to 1.39). Compared with clinical variables alone, the addition of NT-proBNP improved model fit, modestly improved the discrimination (change in area under the curve from 0.764 to 0.773, P = 0.005) and reclassification (continuous net reclassification improvement 0.210, 95% CI, 0.111 to 0.308, improved integrated discrimination 0.0044, 95% CI, 0.0016 to 0.0072) of AKI and non-AKI cases, and achieved higher net benefit in decision curve analysis.ConclusionsPre-operative NT-proBNP concentrations provided predictive information for AKI in a cohort of patients undergoing noncardiac surgery, independent of and incremental to conventional risk factors. Prospective studies are required to confirm this finding and examine its clinical impact.Trial RegistrationChinese Clinical Trial Registry, ChiCTR1900024056. www.chictr.org.cn/showproj.aspx?proj=40385.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

18 keywords...

hide…