title: N-terminal pro-brain natriuretic peptide and angiotensin-converting enzyme-2 levels and their association with postoperative cardiac complications after emergency orthopedic surgery.
abstract: The prognostic usefulness of the cardiac biomarkers N-terminal pro-brain natriuretic peptide (NT-proBNP) and angiotensin-converting enzyme 2 (ACE-2), in predicting adverse cardiac outcomes after orthopedic surgery is not well studied. The aim of our study was to determine the usefulness of perioperative NT-proBNP and ACE-2 for predicting cardiac events after emergency orthopedic surgery. The perioperative NT-proBNP and ACE-2 levels were determined in 187 consecutive patients aged >60 years who underwent orthopedic surgery with 1 year of follow-up for any cardiac complications (defined as acute myocardial infarction, congestive cardiac failure, atrial fibrillation, or major arrhythmia) and death. Of the 187 patients, 20 (10.7%) sustained an in-hospital postoperative cardiac complication. The total all-cause in-hospital and 1-year mortality rate was 1.6% (3 of 187) and 8.6% (16 of 187), respectively. The median preoperative and postoperative NT-proBNP level was greater in patients who sustained an in-hospital cardiac event than in those who had not (386 vs 2,273 pg/ml, p <0.001, and 605 vs 4,316 pg/ml, p <0.001, respectively). Similarly, the postoperative median ACE-2 levels were significantly greater in the patients with an in-hospital cardiac event than in those without (25.3 vs 39.5 pmol/ml/min, p = 0.012). A preoperative NT-proBNP level of ≥741 pg/ml (odds ratio 4.5, 95% confidence interval 1.3 to 15.2, p = 0.017), postoperative troponin elevation (odds ratio 4.9, 95% confidence interval 1.3 to 18.9, p = 0.022), and number of co-morbidities (odds ratio 1.8, 95% confidence interval 1.2 to 2.8, p = 0.009) independently predicted in-hospital cardiac complications on multivariate analysis. The pre- and postoperative NT-proBNP level independently predicted 1-year cardiovascular complications but not the ACE-2 levels. In conclusion, elevated perioperative NT-proBNP predicted in-hospital and 1-year cardiac events in an emergency orthopedic population but the ACE-2 levels did not, which requires additional study for validation.
authors.affiliation: Department of Aged Care, The Northern Hospital, Epping, Victoria, Australia. carol.chong@nh.org.au
authors.forename: Carol P
authors.initials: CP
authors.lastname: Chong
authors.forename: Wen Kwang
authors.initials: WK
authors.lastname: Lim
authors.forename: Elena
authors.initials: E
authors.lastname: Velkoska
authors.forename: William J
authors.initials: WJ
authors.lastname: van Gaal
authors.forename: Julie E
authors.initials: JE
authors.lastname: Ryan
authors.forename: Judy
authors.initials: J
authors.lastname: Savige
authors.forename: Louise M
authors.initials: LM
authors.lastname: Burrell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000085962:Angiotensin-Converting Enzyme 2; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010446:Peptide Fragments / Q000097:blood*; D007703:Peptidyl-Dipeptidase A / Q000097:blood*; D011183:Postoperative Complications; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D007703:Peptidyl-Dipeptidase A; C000705307:ACE2 protein, human; D000085962:Angiotensin-Converting Enzyme 2