title: Serum brain naturietic peptide measurements reflect fluid balance after pancreatectomy.
abstract: BACKGROUND
  Overaggressive fluid resuscitation in elderly patients requiring pancreatectomy can delay recovery and increase morbidity. Despite advancements, no accurate and reproducible methods exist to evaluate effective intravascular volume status in the postoperative setting. We hypothesized that sequential measurement of currently available serum proteins will indicate fluid balance.
  
  
  METHODS
  Clinicopathologic (n = 44) and echocardiogram (echo) data (n = 18) were collected on patients receiving pancreatectomy or diagnostic laparoscopy (n = 5). Measured fluid balance, serum BUN, creatinine (CR), and brain natriuretic peptide (BNP) levels were recorded on postoperative days (POD) 1 to 7 (only POD1 for diagnostic laparoscopy). ANOVA and bivariate random effect models examined the correlation between BNP and BUN/CR and fluid balance. Linear mixed-effect models examined the correlation between factors associated with vascular stiffness and BNP, BUN/CR, and fluid balance.
  
  
  RESULTS
  On POD1 after diagnostic laparoscopy, the fluid balance was positive by 3,265 mL and was accompanied by a >300-point increase in BNP (p = 0.0083). After pancreatectomy, a similar increase in BNP (250 pg/mL) and fluid balance (4,492 mL) on POD1 was observed. During the return to euvolemia, the change in serum BNP levels correlated with fluid balance changes during POD 1 to 3 (p = 0.039), and BUN/CR levels correlated with fluid balance during POD 4 to 7. Patients with risk factors associated with cardiovascular stiffness or echo evidence of poor compliance experienced higher BNP during the postoperative period.
  
  
  CONCLUSIONS
  Fluid loading at surgery is accompanied by an increase in serum BNP, and return to a balanced fluid state after pancreatectomy is paralleled by changes in BNP and BUN/CR levels.
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4008, USA.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Berri
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Sahai
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Durand
authors.forename: Heather Y
authors.initials: HY
authors.lastname: Lin
authors.forename: Justin
authors.initials: J
authors.lastname: Folloder
authors.forename: Marc A
authors.initials: MA
authors.lastname: Rozner
authors.forename: Vijaya
authors.initials: V
authors.lastname: Gottumukkala
authors.forename: Matthew H G
authors.initials: MH
authors.lastname: Katz
authors.forename: Jeffery E
authors.initials: JE
authors.lastname: Lee
authors.forename: Jason B
authors.initials: JB
authors.lastname: Fleming
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D006332:Cardiomegaly / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D004548:Elasticity; D004784:Environmental Monitoring / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010180:Pancreatectomy / Q000009:adverse effects; D011182:Postoperative Care; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control; D012189:Retrospective Studies; D014463:Ultrasonography; D014882:Water-Electrolyte Balance
chemical_list: D020097:Natriuretic Peptide, Brain