The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: A systematic review and individual patient data meta-analysis

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

doi:10.1016/j.jacc.2013.08.1630

The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: A systematic review and individual patient data meta-analysis

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

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

252 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	170-180
Number of pages	11
Journal	Journal of the American College of Cardiology
Volume	63
Issue number	2
DOIs	https://doi.org/10.1016/j.jacc.2013.08.1630
State	Published - 21 Jan 2014

Bibliographical note

Funding Information:
Dr. Rodseth is supported by a Canadian Institutes of Health Research Scholarship (the Canada-HOPE Scholarship) , Ottawa, Canada; the College of Medicine of South Africa (the Phyllis Kocker/Bradlow Award) , Cape Town, South Africa; and the University of KwaZulu-Natal (competitive research grant) , Durban, South Africa. Dr. Biccard is supported by the South African Society of Anaesthesiologists (The Jan Pretorius Research Fund) , Johannesburg, South Africa; and the University of KwaZulu-Natal (competitive research grant) , Durban, South Africa. Dr. Chong is a recipient of a National Health and Medical Research Council (Australia postgraduate research scholarship), Canberra, Australia, and has received research stipends from The University of Melbourne, Melbourne, Australia, and the Northern Clinical Research, Melbourne, Australia. Dr. Mahla has received NT-proBNP kits from Roche Diagnostics GmbH, Mannheim, Germany; and study grants from Novo Nordisk Pharma GmbH, Vienna, Austria, and CSL Behring Biotherapies for Life, Vienna , Austria. Dr. Radović was supported by the Ministry of Science , Belgrade, Republic of Serbia, Research Grant No. 175089 . Dr. Devereaux is supported by a Heart and Stroke Foundation of Ontario Career Investigator Award, Ottawa, Canada. All other support was provided solely from institutional and/or departmental sources. Dr. Di Somma consults for Alere, San Diego, California. Dr. Mahla has received speaker honoraria and consulting fees from CLS Behring Biotherapies for Life, Vienna, Austria, Germany, and Boehringer Ingelheim RCV, GmbH & Co. KG. Dr. Devereaux has received a grant-in-kind from Roche Diagnostics , Basel, Switzerland, to evaluate NT-proBNP and troponin T among patients undergoing noncardiac surgery. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Keywords

anesthesia
myocardial infarction
natriuretic peptides
risk factors
surgery

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Rodseth, R. N., Biccard, B. M., Le Manach, Y., Sessler, D. I., Lurati Buse, G. A., Thabane, L., Schutt, R. C., Bolliger, D., Cagini, L., Cardinale, D., Chong, C. P. W., Chu, R., Cnotliwy, M., Di Somma, S., Fahrner, R., Lim, W. K., Mahla, E., Manikandan, R., Puma, F., ... Devereaux, P. J. (2014). The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: A systematic review and individual patient data meta-analysis. Journal of the American College of Cardiology, 63(2), 170-180. https://doi.org/10.1016/j.jacc.2013.08.1630

Rodseth, Reitze N. ; Biccard, Bruce M. ; Le Manach, Yannick et al. / The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery : B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: A systematic review and individual patient data meta-analysis. In: Journal of the American College of Cardiology. 2014 ; Vol. 63, No. 2. pp. 170-180.

@article{1ec7f6ea446a4af784b09326a7f4fbc1,

title = "The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: A systematic review and individual patient data meta-analysis",

abstract = "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.",

keywords = "anesthesia, myocardial infarction, natriuretic peptides, risk factors, surgery",

author = "Rodseth, {Reitze N.} and Biccard, {Bruce M.} and {Le Manach}, Yannick and Sessler, {Daniel I.} and {Lurati Buse}, {Giovana A.} and Lehana Thabane and Schutt, {Robert C.} and Daniel Bolliger and Lucio Cagini and Daniela Cardinale and Chong, {Carol P.W.} and Rong Chu and Mi{\l}os{\l}aw Cnotliwy and {Di Somma}, Salvatore and Ren{\'e} Fahrner and Lim, {Wen Kwang} and Elisabeth Mahla and Ramaswamy Manikandan and Francesco Puma and Pyun, {Wook B.} and Milan Radovi{\'c} and Sriram Rajagopalan and Stuart Suttie and Thuvaraha Vanniyasingam and {Van Gaal}, {William J.} and Marek Waliszek and Devereaux, {P. J.}",

note = "Funding Information: Dr. Rodseth is supported by a Canadian Institutes of Health Research Scholarship (the Canada-HOPE Scholarship) , Ottawa, Canada; the College of Medicine of South Africa (the Phyllis Kocker/Bradlow Award) , Cape Town, South Africa; and the University of KwaZulu-Natal (competitive research grant) , Durban, South Africa. Dr. Biccard is supported by the South African Society of Anaesthesiologists (The Jan Pretorius Research Fund) , Johannesburg, South Africa; and the University of KwaZulu-Natal (competitive research grant) , Durban, South Africa. Dr. Chong is a recipient of a National Health and Medical Research Council (Australia postgraduate research scholarship), Canberra, Australia, and has received research stipends from The University of Melbourne, Melbourne, Australia, and the Northern Clinical Research, Melbourne, Australia. Dr. Mahla has received NT-proBNP kits from Roche Diagnostics GmbH, Mannheim, Germany; and study grants from Novo Nordisk Pharma GmbH, Vienna, Austria, and CSL Behring Biotherapies for Life, Vienna , Austria. Dr. Radovi{\'c} was supported by the Ministry of Science , Belgrade, Republic of Serbia, Research Grant No. 175089 . Dr. Devereaux is supported by a Heart and Stroke Foundation of Ontario Career Investigator Award, Ottawa, Canada. All other support was provided solely from institutional and/or departmental sources. Dr. Di Somma consults for Alere, San Diego, California. Dr. Mahla has received speaker honoraria and consulting fees from CLS Behring Biotherapies for Life, Vienna, Austria, Germany, and Boehringer Ingelheim RCV, GmbH & Co. KG. Dr. Devereaux has received a grant-in-kind from Roche Diagnostics , Basel, Switzerland, to evaluate NT-proBNP and troponin T among patients undergoing noncardiac surgery. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. ",

year = "2014",

month = jan,

day = "21",

doi = "10.1016/j.jacc.2013.08.1630",

language = "English",

volume = "63",

pages = "170--180",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "2",

}

Rodseth, RN, Biccard, BM, Le Manach, Y, Sessler, DI, Lurati Buse, GA, Thabane, L, Schutt, RC, Bolliger, D, Cagini, L, Cardinale, D, Chong, CPW, Chu, R, Cnotliwy, M, Di Somma, S, Fahrner, R, Lim, WK, Mahla, E, Manikandan, R, Puma, F, Pyun, WB, Radović, M, Rajagopalan, S, Suttie, S, Vanniyasingam, T, Van Gaal, WJ, Waliszek, M & Devereaux, PJ 2014, 'The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: A systematic review and individual patient data meta-analysis', Journal of the American College of Cardiology, vol. 63, no. 2, pp. 170-180. https://doi.org/10.1016/j.jacc.2013.08.1630

The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: A systematic review and individual patient data meta-analysis. / Rodseth, Reitze N.; Biccard, Bruce M.; Le Manach, Yannick et al.
In: Journal of the American College of Cardiology, Vol. 63, No. 2, 21.01.2014, p. 170-180.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery

T2 - B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: A systematic review and individual patient data meta-analysis

AU - Rodseth, Reitze N.

AU - Biccard, Bruce M.

AU - Le Manach, Yannick

AU - Sessler, Daniel I.

AU - Lurati Buse, Giovana A.

AU - Thabane, Lehana

AU - Schutt, Robert C.

AU - Bolliger, Daniel

AU - Cagini, Lucio

AU - Cardinale, Daniela

AU - Chong, Carol P.W.

AU - Chu, Rong

AU - Cnotliwy, Miłosław

AU - Di Somma, Salvatore

AU - Fahrner, René

AU - Lim, Wen Kwang

AU - Mahla, Elisabeth

AU - Manikandan, Ramaswamy

AU - Puma, Francesco

AU - Pyun, Wook B.

AU - Radović, Milan

AU - Rajagopalan, Sriram

AU - Suttie, Stuart

AU - Vanniyasingam, Thuvaraha

AU - Van Gaal, William J.

AU - Waliszek, Marek

AU - Devereaux, P. J.

N1 - Funding Information: Dr. Rodseth is supported by a Canadian Institutes of Health Research Scholarship (the Canada-HOPE Scholarship) , Ottawa, Canada; the College of Medicine of South Africa (the Phyllis Kocker/Bradlow Award) , Cape Town, South Africa; and the University of KwaZulu-Natal (competitive research grant) , Durban, South Africa. Dr. Biccard is supported by the South African Society of Anaesthesiologists (The Jan Pretorius Research Fund) , Johannesburg, South Africa; and the University of KwaZulu-Natal (competitive research grant) , Durban, South Africa. Dr. Chong is a recipient of a National Health and Medical Research Council (Australia postgraduate research scholarship), Canberra, Australia, and has received research stipends from The University of Melbourne, Melbourne, Australia, and the Northern Clinical Research, Melbourne, Australia. Dr. Mahla has received NT-proBNP kits from Roche Diagnostics GmbH, Mannheim, Germany; and study grants from Novo Nordisk Pharma GmbH, Vienna, Austria, and CSL Behring Biotherapies for Life, Vienna , Austria. Dr. Radović was supported by the Ministry of Science , Belgrade, Republic of Serbia, Research Grant No. 175089 . Dr. Devereaux is supported by a Heart and Stroke Foundation of Ontario Career Investigator Award, Ottawa, Canada. All other support was provided solely from institutional and/or departmental sources. Dr. Di Somma consults for Alere, San Diego, California. Dr. Mahla has received speaker honoraria and consulting fees from CLS Behring Biotherapies for Life, Vienna, Austria, Germany, and Boehringer Ingelheim RCV, GmbH & Co. KG. Dr. Devereaux has received a grant-in-kind from Roche Diagnostics , Basel, Switzerland, to evaluate NT-proBNP and troponin T among patients undergoing noncardiac surgery. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

PY - 2014/1/21

Y1 - 2014/1/21

N2 - 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.

AB - 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.

KW - anesthesia

KW - myocardial infarction

KW - natriuretic peptides

KW - risk factors

KW - surgery

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U2 - 10.1016/j.jacc.2013.08.1630

DO - 10.1016/j.jacc.2013.08.1630

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AN - SCOPUS:84892375667

SN - 0735-1097

VL - 63

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

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Rodseth RN, Biccard BM, Le Manach Y, Sessler DI, Lurati Buse GA, Thabane L et al. The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: A systematic review and individual patient data meta-analysis. Journal of the American College of Cardiology. 2014 Jan 21;63(2):170-180. doi: 10.1016/j.jacc.2013.08.1630