title: Postoperative increase in B-type natriuretic peptide levels predicts adverse outcome after cardiac surgery.
abstract: OBJECTIVE
  To evaluate the prognostic implication of changes in postoperative B-type natriuretic peptide (BNP) concentrations in patients undergoing cardiopulmonary bypass for cardiac surgery.
  
  
  METHODS
  A retrospective analysis of prospectively collected clinical data.
  
  
  METHODS
  Cardiothoracic surgery and an intensive care unit (ICU) in a university hospital.
  
  
  METHODS
  The present study included a total of 407 consecutive patients undergoing cardiac surgery.
  
  
  METHODS
  None.
  
  
  RESULTS
  BNP concentrations were measured on admittance to the ICU (D0) and at day 1 after surgery. Patients were divided into quintiles according to their BNP level on admittance to the ICU. The predictive value of absolute changes in BNP levels during the first 24 hours postoperatively was analyzed with Kaplan-Meier estimates of survival and Cox multivariate proportional analysis. Prognostic factors for impaired midterm survival included elevation of the BNP level (HR, 7.3/ log10(x); 95% confidence interval, 1.8-29, p = 0.005). The BNP levels of patients undergoing isolated valve surgery or valve and concomitant CABG surgery were significantly higher (p = 0.012 and p = 0.032, respectively) than those undergoing isolated coronary artery bypass graft surgery. Patients in higher quintiles required ventilation for a longer time (p < 0.001), and prolonged inotropic support (p < 0.001). The mean plasma BNP concentration of 172 pg/mL (median, 64; interquartile range, 172) on arrival at the ICU had a sensitivity of 75% and a specificity of 74% for predicting 1-year mortality.
  
  
  CONCLUSIONS
  Elevated BNP levels on admittance to the ICU and postoperatively increasing BNP levels are associated with adverse postoperative outcome and are predictive of impaired late survival. Sequential postoperative BNP monitoring facilitates the early identification of patients at an increased risk of heart failure and may be used as an adjunct for clinical decision making and optimized patient management.
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Division, Skane University Hospital, Lund, Sweden. shahab.nozohoor@med.lu.se
authors.forename: Shahab
authors.initials: S
authors.lastname: Nozohoor
authors.forename: Johan
authors.initials: J
authors.lastname: Nilsson
authors.forename: Lars
authors.initials: L
authors.lastname: Algotsson
authors.forename: Johan
authors.initials: J
authors.lastname: Sjögren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000096:biosynthesis / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain