title: B-type natriuretic peptide vs. cardiac risk scores for prediction of outcome following major orthopedic surgery.
abstract: OBJECTIVE
  The clinical role of B-type natriuretic peptide (BNP) in preoperative evaluation is not clear. We designed a prospective study to investigate the predictive value of BNP in comparison with established clinical risk scores for the outcome of major orthopedic surgery.
  
  
  METHODS
  Overall 242 elderly patients [80 (74-85) years] undergoing orthopedic surgery were included. Inhospital cardiovascular events and 1-year mortality were the main endpoints.
  
  
  RESULTS
  In total 20 (8.3%) patients had major cardiovascular events (MACE) and 41 (21.1%) died in 1 year. Logistic regression analysis for prediction of cardiac events and 1-year mortality, respectively, revealed a significant prognostic value for the BNP (P < 0.001 and P = 0.041), Goldman (P = 0.013 and P = 0.003), Lee (P = 0.022 and P = 0.200), Detsky (P < 0.001 and P < 0.001), and functional capacity indices (P = 0.034 and P = 0.001). BNP cutoff 149 ng/ml improved discrimination of all scores to predict MACE, and BNP cutoff 89 ng/ml improved discrimination of all scores to predict 1-year mortality (Net Reclassification Improvement, P values < 0.05 in all cases). Age [hazard ratio (HR): 1.100, 95% confidence interval (CI): 1.039-1.166, P = 0.001] and BNP (HR: 1.002, 95% CI: 1.000-1.003, P = 0.041) were independent associates of 1-year mortality.
  
  
  CONCLUSIONS
  Preoperative levels of BNP compare favorably with the Goldman, Lee, Detsky, and functional capacity indices for prognosis of orthopedic surgery. Implementation of natriuretic peptides in cardiac risk scores is promising.
authors.affiliation: aDepartment of Cardiology, KAT General Hospital bDepartment of Orthopaedic, ATTIKON University Hospital, Athens, Greece cDiscipline of Medicine, Flinders University and University of Adelaide, Adelaide, Australia dDepartment of Cardiology, ATTIKON University Hospital eDepartment of Biochemistry, KAT General Hospital, Athens, Greece fDepartment of Cardiology, Leiden University Medical Center, The Netherlands.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Katsanos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Babalis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kafkas
authors.forename: Andreas
authors.initials: A
authors.lastname: Mavrogenis
authors.forename: Darryl
authors.initials: D
authors.lastname: Leong
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.forename: Christos
authors.initials: C
authors.lastname: Varounis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Makris
authors.forename: Aafke
authors.initials: A
authors.lastname: van der Heijden
authors.forename: Maria
authors.initials: M
authors.lastname: Anastasiou-Nana
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain