-
J. Am. Coll. Cardiol. · Jan 2014
Review Meta AnalysisThe 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.
Measuring B-type natriuretic peptides post-operatively improves risk stratification in patients undergoing non-cardiac surgery.
pearl- Reitze N Rodseth, Bruce M Biccard, Yannick Le Manach, Daniel I Sessler, Giovana A Lurati Buse, Lehana Thabane, Robert C Schutt, Daniel Bolliger, Lucio Cagini, Daniela Cardinale, Carol P W Chong, Rong Chu, Miłosław Cnotliwy, Salvatore Di Somma, René Fahrner, Wen Kwang Lim, Elisabeth Mahla, Ramaswamy Manikandan, Francesco Puma, Wook B Pyun, Milan Radović, Sriram Rajagopalan, Stuart Suttie, Thuvaraha Vanniyasingam, William J van Gaal, Marek Waliszek, and P J Devereaux.
- 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. Electronic address: ReitzeRodseth@gmail.com.
- J. Am. Coll. Cardiol. 2014 Jan 21;63(2):170-80.
ObjectivesThe 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.BackgroundPre-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.MethodsWe 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.ResultsEighteen 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.ConclusionsAdditional 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.Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Notes
Knowledge, pearl, summary or comment to share?You can also include formatting, links, images and footnotes in your notes
- Simple formatting can be added to notes, such as
*italics*
,_underline_
or**bold**
. - Superscript can be denoted by
<sup>text</sup>
and subscript<sub>text</sub>
. - Numbered or bulleted lists can be created using either numbered lines
1. 2. 3.
, hyphens-
or asterisks*
. - Links can be included with:
[my link to pubmed](http://pubmed.com)
- Images can be included with:
![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
- For footnotes use
[^1](This is a footnote.)
inline. - Or use an inline reference
[^1]
to refer to a longer footnote elseweher in the document[^1]: This is a long footnote.
.