title: High levels of preoperative and postoperative N terminal B-type natriuretic propeptide influence mortality and cardiovascular complications after noncardiac surgery: A prospective cohort study.
abstract: BACKGROUND
  Major noncardiac surgery is associated with a 5% incidence of serious cardiovascular complications and with a 1 to 2% probability of death from cardiac causes. Over the last few decades, researchers have assessed the perioperative predictive power of several risk indices. Research is currently focused on the evaluation of biomarkers.
  
  
  OBJECTIVE
  The objective was to determine the incidence of high serum levels of N terminal B-type natriuretic propeptide (NT-proBNP) before and after surgery in adults undergoing elective major noncardiac procedures and to evaluate its relationship with mortality and cardiovascular complications occurring up to 30 days after surgery.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Enrolment was undertaken at a university hospital from October 2011 to July 2013.
  
  
  METHODS
  A total of 304 adults with cardiovascular risk factors who underwent noncardiac elective surgery.
  
  
  METHODS
  The relationship between preoperative and postoperative NT-proBNP serum levels and the emergence of cardiovascular complications, including all-cause mortality, during the first 30 days after surgery.
  
  
  RESULTS
  The incidence of cardiovascular complications was 7.8% (n = 25), and the mortality rate was 4.3% (n = 13). Higher-than-normal NT-proBNP serum levels were found before surgery in 48.4% (n = 147) and after surgery in 50.7% (n = 154) of patients. The variables found to be independent predictors of cardiovascular complications, including all-cause 30-day mortality, were levels of NT-proBNP more than 300 pg ml before surgery and levels more than 1000 pg ml both before and after surgery.
  
  
  CONCLUSIONS
  High levels of preoperative and postoperative NT-proBNP are predictors of cardiovascular complications, including all-cause mortality, during the first 30 days after noncardiac surgery in adults with cardiovascular risk factors.
authors.affiliation: From the Anaesthesiology and Critical Care Service, Hospital Universitario de La Princesa, Madrid, Spain (CAZ, APR, EAM, FRR, RMH), and Biostatistics, Methodology Unit, Instituto de Investigación Sanitaria-Princesa, Hospital Universitario de La Princesa, Madrid, Spain (LVP).
authors.forename: Carlos
authors.initials: C
authors.lastname: Álvarez Zurro
authors.forename: Antonio
authors.initials: A
authors.lastname: Planas Roca
authors.forename: Enrique
authors.initials: E
authors.lastname: Alday Muñoz
authors.forename: Lorena
authors.initials: L
authors.lastname: Vega Piris
authors.forename: Fernando
authors.initials: F
authors.lastname: Ramasco Rueda
authors.forename: Rosa
authors.initials: R
authors.lastname: Méndez Hernández
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology / Q000401:mortality*; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain