title: Preoperative brain natriuretic peptide (BNP) is a better predictor of adverse cardiac events compared to preoperative scoring system in patients who underwent abdominal surgery.
abstract: BACKGROUND
  Cardiovascular disease is the leading cause of perioperative death in surgical patients. A variety of clinical scoring systems have been developed to predict adverse cardiovascular events. B-type natriuretic peptide (BNP) is a sensitive and specific predictor of left ventricular systolic dysfunction and predicts first cardiovascular event and death in the general population. We present a prospective, single-center, observational cohort study of patients undergoing major abdominal surgery and evaluate the role of BNP in predicting adverse cardiac events.
  
  
  METHODS
  A total of 205 patients were included in the study. All patients were assessed by a cardiological clinical evaluation, a 12-lead ECG report, and a preoperative and postoperative blood sample for plasmatic BNP assessment. The primary end point was the predictive power of preoperative BNP levels for adverse cardiac events until 30 days after discharge.
  
  
  RESULTS
  Thirty-one of 205 (15%) patients had adverse cardiac events in the postoperative period up to 30 days after discharge. Five patients (2.4%) of these died of cardiac events. Preoperative BNP values were significantly increased in the 31 patients compared to the other patients in the postoperative period [mean = 112.93 pg/ml (range = 5-2,080) vs. 178.99 pg/ml (range = 5-3,980); median = 117 vs. 23 pg/ml; 95% CI = 49-181; p < 0.0001]. At logistic regression, a preoperative BNP value of >36 pg/ml was the only effective predictor of adverse cardiac events.
  
  
  CONCLUSIONS
  We have demonstrated that elevated preoperative BNP levels are independent predictors of adverse cardiac events in a cohort of patients undergoing major abdominal surgery in a general surgery department, and this is the first study about this specific cohort of patients.
authors.affiliation: Department of Surgery, University of Rome "La Sapienza", II° Faculty of Medicine and Surgery, Azienda Ospedaliera Sant'Andrea, Via di Grottarossa, 1035-39, 00189 Rome, Italy. paolo.mercantini@uniroma1.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Mercantini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.forename: Laura
authors.initials: L
authors.lastname: Magrini
authors.forename: Andrea
authors.initials: A
authors.lastname: Kazemi Nava
authors.forename: Andrea
authors.initials: A
authors.lastname: Scarinci
authors.forename: Marco
authors.initials: M
authors.lastname: La Torre
authors.forename: Mario
authors.initials: M
authors.lastname: Ferri
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferri
authors.forename: Niccolò
authors.initials: N
authors.lastname: Petrucciani
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ziparo
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000401:mortality; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011183:Postoperative Complications / Q000401:mortality; D011184:Postoperative Period; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D013514:Surgical Procedures, Operative; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
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