The Prognostic Value of Pre-Operative and Post-Operative B-Type Natriuretic Peptides in Patients Undergoing Noncardiac Surgery Academic Article uri icon

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  • OBJECTIVES: The objective of this study was to determine whether measuring post-operative B-type natriuretic peptides (NPs) (i.e., B-type natriuretic peptide [BNP] and N-terminal fragment of proBNP [NT-proBNP]) enhances risk stratification in adult patients undergoing noncardiac surgery, in whom a pre-operative NP has been measured. BACKGROUND: Pre-operative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated post-operative NP concentrations are independently associated with these complications. It is not clear whether there is value in measuring post-operative NP when a pre-operative measurement has been done. METHODS: We conducted a systematic review and individual patient data meta-analysis to determine whether the addition of post-operative NP levels enhanced the prediction of the composite of death and nonfatal myocardial infarction at 30 and ≥180 days after surgery. RESULTS: Eighteen eligible studies provided individual patient data (n = 2,179). Adding post-operative NP to a risk prediction model containing pre-operative NP improved model fit and risk classification at both 30 days (corrected quasi-likelihood under the independence model criterion: 1,280 to 1,204; net reclassification index: 20%; p < 0.001) and ≥180 days (corrected quasi-likelihood under the independence model criterion: 1,320 to 1,300; net reclassification index: 11%; p = 0.003). Elevated post-operative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio: 3.7; 95% confidence interval: 2.2 to 6.2; p < 0.001) and ≥180 days (odds ratio: 2.2; 95% confidence interval: 1.9 to 2.7; p < 0.001) after surgery. CONCLUSIONS: Additional post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and ≥180 days after noncardiac surgery compared with a pre-operative NP measurement alone.


  • Rodseth, Reitze N
  • Biccard, Bruce M
  • Le Manach, Yannick Arnaud
  • Sessler, Daniel I
  • Lurati Buse, Giovana A
  • Thabane, Lehana
  • Schutt, Robert C
  • Bolliger, Daniel
  • Cagini, Lucio
  • Cardinale, Daniela
  • Chong, Carol PW
  • Chu, Rong
  • Cnotliwy, Miłosław
  • Di Somma, Salvatore
  • Fahrner, René
  • Lim, Wen Kwang
  • Mahla, Elisabeth
  • Manikandan, Ramaswamy
  • Puma, Francesco
  • Pyun, Wook B
  • Radović, Milan
  • Rajagopalan, Sriram
  • Suttie, Stuart
  • Vanniyasingam, Thuvaraha
  • van Gaal, William J
  • Waliszek, Marek
  • Devereaux, Philip

publication date

  • January 2014

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