title: NT-pro BNP secretion and clinical endpoints in cardiac surgery intensive care patients.
abstract: The primary objective of this study was to determine the pattern of N-Terminal pro brain natriuretic peptide (NT-pro BNP) secretion pre and post cardiac surgery and then to investigate the correlation between levels of serum NT-pro BNP and postoperative clinical and biochemical endpoints. This was a prospective observational study performed at a tertiary centre in New Zealand, examining 118 adult patients undergoing cardiac surgery. Interventions included blood samples for NT-pro BNP and troponin-T taken 48 hours prior to operation and 12, 36 and 72 hours postoperatively. The plasma NT-pro BNP levels increased fourfold postoperatively, to plateau at 36 to 72 hours. Preoperative NT-pro BNP levels correlated with ventilation time (r = 0.46), length of stay in intensive care unit (r = 0.59), total perioperative noradrenaline dose (r = 0.55), but not with postoperative atrial fibrillation or mortality. Using multivariate analysis, serum NT-pro BNP levels at 36 hours were associated with increased noradrenaline dose (P = 0.001), decreased preoperative ejection fraction (EF) Group (P = 0.013) and elevated preoperative NT-pro BNP (P < 0.001). Factors not associated with NT-pro BNP levels at 36 hours include the operation type, bypass and cross-clamp times, use of milrinone and troponin-T We conclude that NT-pro BNP levels increased markedly after cardiac surgery and that high preoperative NT-pro BNP levels are associated with a slow postoperative recovery, but do not predict the occurrence of postoperative atrial fibrillation or mortality. Myocardial ischaemia is an unlikely cause of the NT-pro BNP elevation, because no correlation existed between troponin-T and NT-pro BNP levels.
authors.affiliation: Intensive Care Unit, Waikato Hospital, Hamilton, New Zealand.
authors.forename: P M
authors.initials: PM
authors.lastname: Jogia
authors.forename: M
authors.initials: M
authors.lastname: Kalkoff
authors.forename: J W
authors.initials: JW
authors.lastname: Sleigh
authors.forename: A
authors.initials: A
authors.lastname: Bertinelli
authors.forename: M
authors.initials: M
authors.lastname: La Pine
authors.forename: A M
authors.initials: AM
authors.lastname: Richards
authors.forename: G
authors.initials: G
authors.lastname: Devlin
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000401:mortality; D003325:Coronary Care Units; D023381:Endpoint Determination / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009520:New Zealand; D009638:Norepinephrine / Q000008:administration & dosage; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D012372:ROC Curve; D013318:Stroke Volume; D013997:Time Factors; D020107:Troponin T / Q000097:blood; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; D014662:Vasoconstrictor Agents; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009638:Norepinephrine