Usefulness of N-terminal pro-brain natriuretic peptide to predict postoperative cardiac complications and long-term mortality after emergency lower limb orthopedic surgery.
After emergency orthopedic-geriatric surgery, cardiac complications are an important cause of morbidity and mortality. The utility of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) for the prediction of cardiac complications and mortality was evaluated. NT-pro-BNP was tested pre- and postoperatively in 89 patients >60 years of age. They were followed for 2 years for cardiac complications (defined as acute myocardial infarction, congestive cardiac failure, atrial fibrillation or major arrhythmia) or death. Receiver operating characteristic curves were constructed to determine the optimal discriminatory level for cardiac events and death using NT-pro-BNP. Twenty-three patients (25.8%) sustained an in-hospital postoperative cardiac complication. Total all-cause mortality was 3 of 89 (3.4%) in hospital, 21 of 89 (23.6%) at 1 year, and 27 of 89 (30.3%) at 2 years. Median preoperative and postoperative NT-pro-BNP levels were higher in patients who had an in-hospital cardiac event compared to those without (387 vs 1,969 pg/ml, p <0.001; and 676 vs 7,052 pg/ml, p <0.001 respectively). The optimal discriminatory level for preoperative NT-pro-BNP was 842 pg/ml and that for postoperative NT-pro-BNP was 1,401 pg/ml for the prediction of in-hospital cardiac events and 1- and 2-year mortality. Preoperative NT-pro-BNP >/=842 pg/ml (odds ratio 11.6, 95% confidence interval 2.1 to 65.0, p = 0.005) was an independent predictor of in-hospital cardiac complications using multivariate analysis and pre- and postoperative NT-pro-BNP levels were independent predictors of 2-year cardiovascular events. Patients who had preoperative NT-pro-BNP >/=842 pg/ml or postoperative NT-pro-BNP >/=1,401 pg/ml had significantly worse survival using log-rank testing (p <0.001) and these variables independently predicted 2-year mortality. In conclusion, increase pre- and postoperative NT-pro-BNP levels are independent predictors of in-hospital cardiac events and 1- and 2-year mortality in older patients undergoing emergency orthopedic surgery.
Chong
Carol P
CP
Department of Aged Care, The Northern Hospital, Epping, Victoria, Australia. carol.chong@nh.org.au
Ryan
Julie E
JE
van Gaal
William J
WJ
Lam
Que T
QT
Sinnappu
Rabindra N
RN
Burrell
Louise M
LM
Savige
Judy
J
Lim
Wen Kwang
WK
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016001:Confidence Intervals; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010446:Peptide Fragments / Q000097:blood*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011446:Prospective Studies; D016019:Survival Analysis
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain