title: N-terminal fragment of pro-B-type natriuretic peptide is a predictor of cardiac events in high-risk patients undergoing acute hip fracture surgery.
abstract: BACKGROUND
  The aim of this investigation was to assess the incidence of elevated N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) and its relation to outcome defined as perioperative adverse cardiac events and all-cause mortality in high-risk patients undergoing non-elective surgery for hip fracture.
  
  
  METHODS
  A cohort of patients with hip fractures were extracted from a prospective observational study of high-risk patients (ASA class III or IV) undergoing emergency surgery. NT-proBNP and troponin I were measured before operation. An NT-proBNP > or = 3984 ng litre(-1) was set as the cut-off level for significance. Perioperative adverse cardiac events and 30 day and 3 month mortality were recorded.
  
  
  RESULTS
  Sixty-nine subjects were included. Thirty-four subjects (49%) had an NT-proBNP > or = 3984 ng litre(-1) before surgery. Thirty-four subjects (49%) had a perioperative adverse cardiac event. Of these, 22 subjects (65%) had NT-proBNP above the diagnostic threshold compared with 12 subjects (34%) who had an NT-proBNP below the diagnostic threshold (P=0.01). Preoperative NT-proBNP > or = 3984 ng litre(-1) [odds ratio (OR) 3.0; 95% confidence interval (CI) 1.0-8.9] and congestive heart failure (OR 3.0; 95% CI 1.0-9.0) were independent predictors of perioperative adverse cardiac events. A total of eight subjects (12%) died within 30 days after operation.
  
  
  CONCLUSIONS
  There is a high incidence of elevated NT-proBNP in subjects undergoing non-elective hip fracture surgery. Preoperative NT-proBNP is a valuable predictor of cardiac complications in the perioperative period.
authors.affiliation: Division of Anaesthesia, Department of Medical and Health Sciences, Linkoping University, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Oscarsson
authors.forename: M
authors.initials: M
authors.lastname: Fredrikson
authors.forename: M
authors.initials: M
authors.lastname: Sörliden
authors.forename: S
authors.initials: S
authors.lastname: Anskär
authors.forename: C
authors.initials: C
authors.lastname: Eintrei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology; D004630:Emergencies; D005260:Female; D006620:Hip Fractures / Q000097:blood / Q000601:surgery*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain