title: Prognostic Value of Preoperative Brain Natriuretic Peptide Serum Levels in Liver Transplantation.
abstract: BACKGROUND
  Brain natriuretic peptide (BNP) serum concentration has been shown to be a preoperative predictor of postoperative outcome in high risk surgery. Whether it is able to predict early post-liver transplantation (LT) mortality in cirrhotic patients is unanswered.
  
  
  METHODS
  Prospective monocenter observational study including all consecutive patients who received LT for cirrhosis and for whom a preoperative BNP serum dosage was available between January 2011 and December 2014.
  
  
  RESULTS
  During the period, 207 cirrhotic patients among 525 LT were studied. The ICU and 180-day mortality rates were, respectively, 6% and 8%. Pre-LT BNP concentration, adjusted on model of end-stage liver disease (MELD) score, was an independent factor of ICU and 180-day mortality rates (for each 50 pg/mL increase; hazard ratio, 1035 [1.022-1.049]; P < 0.001 and 1.035 [1.014-1057]; P = 0.001). According to the receiver operator characteristic curve with an accuracy of 0.79 (0.66-0.93), the optimal cutoff value of pre-LT BNP serum level to predict ICU mortality was 155 pg/mL with a negative predictive value of 99%. All patients with MELD score exceeding 25 and pre-LT serum BNP level less than 155 pg/mL survived, whereas patients combining MELD score exceeding 25 and pre-LT BNP concentration exceeding 155 pg/mL had a 27% ICU mortality rate (P = 0.03).
  
  
  CONCLUSIONS
  In cirrhotic patients, pre-LT BNP serum level was an independent predictor of post-LT ICU mortality. With its excellent negative predictive value, the use of this biomarker in combination with MELD score could be useful to better predict post-LT early outcome.
authors: 1 APHP-HUPNVS, Department of Anesthesiology and Critical Care, Beaujon Hospital, Clichy, France. 2 Paris VII-Denis Diderot University, Paris, France. 3 INSERM UMR S 1149, Inflammation Research Center, Paris, France. 4 APHP, Department of Anesthesiology and Critical Care, Lariboisière Hospital, Paris, France. 5 INSERM UMR 942, Paris VII University, Paris, France.
authors: Amelie
authors: A
authors: Toussaint
authors: Emmanuel
authors: E
authors: Weiss
authors: Linda
authors: L
authors: Khoy-Ear
authors: Sylvie
authors: S
authors: Janny
authors: Jacqueline
authors: J
authors: Cohen
authors: Didier
authors: D
authors: Delefosse
authors: Lucie
authors: L
authors: Guillemet
authors: Etienne
authors: E
authors: Gayat
authors: Catherine
authors: C
authors: Paugam-Burtz
mesh_terms: D015415:Biomarkers / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010297:Paris; D011237:Predictive Value of Tests; D011300:Preoperative Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain