title: Plasma BNP level combined with surgical Apgar score to predict operative major cardiac adverse events in malignant obstructive jaundice patients.
abstract: OBJECTIVE
  To investigate the predictive effect of major adverse cardiac events (MACE) in malignant obstructive jaundice (OJ) patients using plasma brain natriuretic peptide (BNP) level and surgical Apgar scoring (SAS) system.
  
  
  METHODS
  Forty one malignant OJ patients undergoing surgical treatments were studied at a single center. Pre-and postoperative plasma BNP level, total bilirubin (TBil) and data of cardiac function (HR, CVP, CI, LVEF%) were detected, the SAS was calculated during the surgery, the relationship of both plasma BNP level and SAS with MACE after surgery was analyzed.
  
  
  RESULTS
  Thirteen patients out of 41 (31.71%) experienced MACE without cardiac death. OJ patients had a higher plasma BNP level than baseline before operation (191.61±105.76 pg/ml VS 175 pg/ml, P<0.05), the cardiac function data was improved (CVP: t=4.761,p=0.000; CI: t=3.539,p=0.001; LVEF%: t=3.632,p=0.001) after the operation. Patients with lower SAS had increasing incidence of MACE after surgery.
  
  
  CONCLUSIONS
  Malignant OJ patients with higher preoperative BNP level and lower surgical Apgar score were identified at high risk of MACE after surgery.
authors.affiliation: Wei Yu, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Yu
authors.affiliation: Changshan Huang, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China.
authors.forename: Changshan
authors.initials: C
authors.lastname: Huang
authors.affiliation: Qian Wang, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Erjiang Zhao, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China.
authors.forename: Erjiang
authors.initials: E
authors.lastname: Zhao
authors.affiliation: Yuechao Ding, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China.
authors.forename: Yuechao
authors.initials: Y
authors.lastname: Ding
authors.affiliation: Tao Huang, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Huang
authors.affiliation: Chao Ma, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Ma
authors.affiliation: Bo Meng, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Meng
keywords: Main adverse cardiac events (MACE); Obstructive jaundice (OJ); Plasma brain natriuretic peptide (BNP); Surgical Apgar score