title: Role of N-terminal pro B-type natriuretic peptide in identifying patients at high risk for adverse outcome after emergent non-cardiac surgery.
abstract: BACKGROUND
  Patients undergoing emergency surgery continue to be at very high risk, but accurate risk identification for the individual patient remains difficult. This study tested the usefulness of perioperative N-terminal pro B-type natriuretic peptide (NT-proBNP) for in-hospital and long-term risk stratification.
  
  
  METHODS
  We conducted a prospective single-centre observational cohort study in an Austrian university hospital. Two hundred and ninety-seven consecutive patients >50 yr of age undergoing a variety of emergency non-cardiac procedures were included. The primary endpoint was a composite of non-fatal myocardial infarction (MI), acute heart failure, or death between index surgery and 3 yr follow-up. The secondary endpoint was in-hospital major adverse cardiac events (MACE), defined as non-fatal MI, acute heart failure, or cardiac death.
  
  
  RESULTS
  During a median follow-up of 34 months (inter-quartile range: 16-39), 31% of subjects reached the primary endpoint. A preoperative NT-proBNP ≥725 pg ml(-1) was associated with a 4.8-fold univariate relative risk [95% confidence interval (CI): 3.1-7.6] and a postoperative NT-proBNP ≥1600 pg ml(-1) was associated with a four-fold univariate relative risk (95% CI: 2.7-6.2) for reaching the primary endpoint. Moreover, preoperative NT-proBNP remained a significant and independent (hazards ratio 1.91, 95% CI 1.08-3.37, P=0.027) predictor in a multivariate Cox proportional hazards model. A preoperative NT-proBNP ≥1740 pg ml(-1) was associated with a 6.9-fold univariate relative risk (95% CI: 3.5-13.4) for MACE during the index hospital stay, but did not remain significant in a multivariate logistic regression model.
  
  
  CONCLUSIONS
  Preoperative NT-proBNP can help identify patients at high risk for adverse long-term outcome after emergency surgery.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria. sylvia.farzi@medunigraz.at
authors.forename: S
authors.initials: S
authors.lastname: Farzi
authors.forename: T
authors.initials: T
authors.lastname: Stojakovic
authors.forename: Th
authors.initials: T
authors.lastname: Marko
authors.forename: C
authors.initials: C
authors.lastname: Sankin
authors.forename: P
authors.initials: P
authors.lastname: Rehak
authors.forename: R
authors.initials: R
authors.lastname: Gumpert
authors.forename: A
authors.initials: A
authors.lastname: Baumann
authors.forename: B
authors.initials: B
authors.lastname: Höfler
authors.forename: H
authors.initials: H
authors.lastname: Metzler
authors.forename: E
authors.initials: E
authors.lastname: Mahla
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D004562:Electrocardiography; D004632:Emergency Medical Services; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006400:Hematocrit; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011184:Postoperative Period; D057234:Preoperative Period; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain