title: Predictive value of plasma brain natriuretic peptide for postoperative cardiac complications--a systemic review and meta-analysis.
abstract: BACKGROUND
  We aimed to undertake a systematic review and meta-analysis of studies addressing perioperative natriuretic peptide (NP) levels to predict postoperative major adverse cardiac events (MACE) after major surgery.
  
  
  METHODS
  We searched MEDLINE and Embase with no language restrictions up to May 2013. The end points were major cardiac complications. We summarized test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random effects models.
  
  
  RESULTS
  Of the 662 retrieved articles, 24 studies satisfied the predefined eligibility criteria, including 5438 patients along with 712 (13.1%) events. After major surgery, the diagnostic odds ratio (DOR) of NP in predicting postoperative MACE was 14.3 (95% confidence interval [CI], 9.87-20.7) for overall population, 13.9 (8.43-22.8) for patients undergoing cardiac surgery, and 15.0 (8.84-25.5) for patients undergoing noncardiac surgery. The pooled sensitivity was 0.84 (95% CI, 0.79-0.88) and specificity was 0.76 (95% CI, 0.71-0.81). Postoperative measurement (DOR, 18.9; 7.68-46.3) was associated with higher predictive value than preoperative measurement (DOR, 13.6; 7.68-46.3). Results were similar for a subgroup with the composite outcome including mortality (DOR, 16.4; 10.6-25.5). B-type natriuretic peptide was associated with higher predictive accuracy (area under the summary receiver operating characteristic, 0.84; 0.81-0.87) than N-terminal pro-b-type natriuretic peptide (area under the summary receiver operating characteristic, 0.90; 0.87-0.92).
  
  
  CONCLUSIONS
  The existing literature suggests that perioperative NP testing have reasonable accuracy and can be useful in perioperative risk stratification. Natriuretic peptide testing has high rule-out value and low rule-in value for predicting postoperative MACE. Medical decisions should be made in the context of these characteristics.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzih City, Chiayi County, 613, Taiwan; Chang Gung University College of Medicine, Gueishan Township, Taoyuan County, 333, Taiwan.
authors.forename: Yui-Rwei
authors.initials: YR
authors.lastname: Young
authors.affiliation: Chang Gung University College of Medicine, Gueishan Township, Taoyuan County, 333, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Gueishan Township, Taoyuan County, 333, Taiwan.
authors.forename: Bor-Fuh
authors.initials: BF
authors.lastname: Sheu
authors.affiliation: Chang Gung University College of Medicine, Gueishan Township, Taoyuan County, 333, Taiwan; Department of Occupation Medicine, Chang-Gung Memorial Hospital, Chiayi Branch, Puzih City, Chiayi County, 613, Taiwan.
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Li
authors.affiliation: Chang Gung University College of Medicine, Gueishan Township, Taoyuan County, 333, Taiwan; Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung Branch, Kaohsiung County, 833, Taiwan.
authors.forename: Ting-Min
authors.initials: TM
authors.lastname: Hsieh
authors.affiliation: Chang Gung University College of Medicine, Gueishan Township, Taoyuan County, 333, Taiwan; Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung County, 833, Taiwan.
authors.forename: Chi-Wei
authors.initials: CW
authors.lastname: Hung
authors.affiliation: Chang Gung University College of Medicine, Gueishan Township, Taoyuan County, 333, Taiwan; Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: sschang0529@gmail.com.
authors.forename: Shy-Shin
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Department of Emergency Medicine, National Taiwan University Hospital, Douliou, Yunlin Branch, Taiwan and Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: cclee100@gmail.com.
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Lee
mesh_terms: D015415:Biomarkers / Q000097:blood; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; Cardiac complication; N-terminal pro–b-type natriuretic peptide; Surgery