title: Preoperative B-type natriuretic peptide, and not the inflammation status, predicts an adverse outcome for patients undergoing heart surgery.
abstract: OBJECTIVE
  B-type natriuretic peptide (BNP) and inflammatory markers are implicated in the pathophysiology of both ischemic cardiomyopathy and complications after cardiac surgery with cardiopulmonary bypass (CPB). The purpose of this study was to assess preoperative and postoperative levels of BNP, interleukin-6 (IL-6), interleukin-8 (IL-8), P-selectin, intercellular adhesion molecule (ICAM), C-reactive protein (CRP) in patients undergoing cardiac surgery with CPB and investigate their variation and ability to correlate with immediate outcome.
  
  
  METHODS
  Plasma levels of these markers were measured preoperatively, 6 and 24 h after CBP in 62 patients. Main endpoints were requirements for intra-aortic balloon pump, intensive care unit (ICU) stay longer than five days, ventilator dependence >24 h, requirement for dobutamine, hospital stay >10 days, clinical complications (infection, myocardial infarction, renal failure, stroke and ventricular arrhythmias) and in-hospital mortality.
  
  
  RESULTS
  Preoperative BNP levels correlate with longer ICU stay (P = 0.003), longer ventilator use (P = 0.018) and duration of dobutamine use (P < 0.001). The receiver-operating characteristic curve demonstrated BNP levels >190 pg/ml as predictor of ICU >5 days and BNP levels >20.5 pg/ml correlated with dobutamine use, with areas under the curve of 0.712 and 0.842, respectively. Preoperative levels of ICAM-1 were associated with in-hospital mortality (P = 0.042). In the postoperative period, was found association between CRP, IL-6 and P-selectin with ventilation duration (P = 0.013, P = 0.006, P < 0.001, respectively) and P-selectin with ICU stay (P = 0.009).
  
  
  CONCLUSIONS
  BNP correlates with clinical endpoints more than inflammatory markers and can be used as a predictor of early outcome after heart surgery.
authors.affiliation: Heart Institute (InCor), Medical School, University of Säo Paulo, Säo Paulo, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ganem
authors.forename: Carlos V
authors.initials: CV
authors.lastname: Serrano
authors.forename: Juliano L
authors.initials: JL
authors.lastname: Fernandes
authors.forename: Maria Heloísa S L
authors.initials: MH
authors.lastname: Blotta
authors.forename: Juliana A
authors.initials: JA
authors.lastname: Souza
authors.forename: José C
authors.initials: JC
authors.lastname: Nicolau
authors.forename: José A F
authors.initials: JA
authors.lastname: Ramires
authors.forename: Whady A
authors.initials: WA
authors.lastname: Hueb
mesh_terms: D000178:Acrylamides / Q000097:blood; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001938:Brazil; D002097:C-Reactive Protein / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D004280:Dobutamine / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications* / Q000401:mortality; D018836:Inflammation Mediators / Q000097:blood*; D007362:Intensive Care Units; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D019007:P-Selectin / Q000097:blood; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012372:ROC Curve; D012121:Respiration, Artificial; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000097:blood
chemical_list: C531963:2-(2,6-dichloro-4-((3-furan-2-ylacryloylamino)methyl)benzoylamino)-3-((thiazolidine-4-carbonyl)amino)propionic acid; D000178:Acrylamides; D015415:Biomarkers; C508606:CXCL8 protein, human; D002316:Cardiotonic Agents; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8; D019007:P-Selectin; C546937:SELP protein, human; D020097:Natriuretic Peptide, Brain; D015091:beta-Alanine; D004280:Dobutamine; D002097:C-Reactive Protein