title: Postoperative B-type natriuretic peptide for prediction of major cardiac events in patients undergoing noncardiac surgery: systematic review and individual patient meta-analysis.
abstract: BACKGROUND
  It is unclear whether postoperative B-type natriuretic peptides (i.e., BNP and N-terminal proBNP) can predict cardiovascular complications in noncardiac surgery.
  
  
  METHODS
  The authors undertook a systematic review and individual patient data meta-analysis to determine whether postoperative BNPs predict postoperative cardiovascular complications at 30 and 180 days or more.
  
  
  RESULTS
  The authors identified 18 eligible studies (n = 2,051). For the primary outcome of 30-day mortality or nonfatal myocardial infarction, BNP of 245 pg/ml had an area under the curve of 0.71 (95% CI, 0.64-0.78), and N-terminal proBNP of 718 pg/ml had an area under the curve of 0.80 (95% CI, 0.77-0.84). These thresholds independently predicted 30-day mortality or nonfatal myocardial infarction (adjusted odds ratio [AOR] 4.5; 95% CI, 2.74-7.4; P < 0.001), mortality (AOR, 4.2; 95% CI, 2.29-7.69; P < 0.001), cardiac mortality (AOR, 9.4; 95% CI, 0.32-254.34; P < 0.001), and cardiac failure (AOR, 18.5; 95% CI, 4.55-75.29; P < 0.001). For greater than or equal to 180-day outcomes, natriuretic peptides independently predicted mortality or nonfatal myocardial infarction (AOR, 3.3; 95% CI, 2.58-4.3; P < 0.001), mortality (AOR, 2.2; 95% CI, 1.67-86; P < 0.001), cardiac mortality (AOR, 2.1; 95% CI, 0.05-1,385.17; P < 0.001), and cardiac failure (AOR, 3.5; 95% CI, 1.0-9.34; P = 0.022). Patients with BNP values of 0-250, greater than 250-400, and greater than 400 pg/ml suffered the primary outcome at a rate of 6.6, 15.7, and 29.5%, respectively. Patients with N-terminal proBNP values of 0-300, greater than 300-900, and greater than 900 pg/ml suffered the primary outcome at a rate of 1.8, 8.7, and 27%, respectively.
  
  
  CONCLUSIONS
  Increased postoperative BNPs are independently associated with adverse cardiac events after noncardiac surgery.
authors.affiliation: Perioperative Research Group, Department of Anaesthetics, Inkosi Albert Luthuli Central Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Reitze N
authors.initials: RN
authors.lastname: Rodseth
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Biccard
authors.forename: Rong
authors.initials: R
authors.lastname: Chu
authors.forename: Giovana A
authors.initials: GA
authors.lastname: Lurati Buse
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Ameet
authors.initials: A
authors.lastname: Bakhai
authors.forename: Daniel
authors.initials: D
authors.lastname: Bolliger
authors.forename: Lucio
authors.initials: L
authors.lastname: Cagini
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Cahill
authors.forename: Daniela
authors.initials: D
authors.lastname: Cardinale
authors.forename: Carol P W
authors.initials: CP
authors.lastname: Chong
authors.forename: Miłosław
authors.initials: M
authors.lastname: Cnotliwy
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.forename: René
authors.initials: R
authors.lastname: Fahrner
authors.forename: Wen K
authors.initials: WK
authors.lastname: Lim
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Mahla
authors.forename: Yannick
authors.initials: Y
authors.lastname: Le Manach
authors.forename: Ramaswamy
authors.initials: R
authors.lastname: Manikandan
authors.forename: Wook B
authors.initials: WB
authors.lastname: Pyun
authors.forename: Sriram
authors.initials: S
authors.lastname: Rajagopalan
authors.forename: Milan
authors.initials: M
authors.lastname: Radovic
authors.forename: Robert C
authors.initials: RC
authors.lastname: Schutt
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.forename: Stuart
authors.initials: S
authors.lastname: Suttie
authors.forename: Thuvaraha
authors.initials: T
authors.lastname: Vanniyasingam
authors.forename: Marek
authors.initials: M
authors.lastname: Waliszek
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D006331:Heart Diseases / Q000097:blood* / Q000453:epidemiology* / Q000401:mortality; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology* / Q000401:mortality; D011184:Postoperative Period; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain