Department of Anesthesia and Intensive Care Medicine, University Hospital Basel, Spitalstrasse 21CH-4031, Basel, Switzerland.
Anesth Analg. 2011 May;112(5):1019-33. doi: 10.1213/ANE.0b013e31820f286f. Epub 2011 Mar 3.
Several studies have evaluated preoperative B-type natriuretic peptides (NPs) for predicting mortality after surgery; however, the number of deaths in each study was small, limiting the power of these studies. We conducted a systematic review and meta-analysis of studies addressing preoperative NP levels to predict mortality after cardiac and noncardiac surgery.
We searched MEDLINE and EMBASE using the terms "natriuretic peptides," "surgery or surgical procedures," and a validated combination of prognostic and diagnostic terms. Two investigators independently assessed studies for eligibility and extracted data. The end points were all-cause mortality at ≥6 months and at ≤90 days. We used a bivariate model to derive measures of prognostic accuracy and their heterogeneity. We calculated the pooled positive predictive value (PPV) and negative predictive value (NPV) by Bayesian Markov chain Monte Carlo methods.
Of the 1558 retrieved articles, 23 studies satisfied the predefined eligibility criteria. After cardiac surgery, the diagnostic odds ratio of NP was 4.11 (95% confidence interval, 2.22-7.60) for ≥6-month mortality, the PPV 0.17 (95% Bayesian confidence interval, 0.07-0.36), and the NPV 0.96 (0.90-0.98). After noncardiac surgery, the diagnostic odds ratio of NP was 4.97 (3.06-8.07) for ≥6-month mortality. The corresponding PPV was 0.24 (0.14-0.38) and the NPV 0.94 (0.88-0.97). Results were similar for ≤90-day mortality.
Preoperative NP concentrations were associated with mortality after cardiac and noncardiac surgery. NP had high NPVs for both types of surgery suggesting that preoperative NP concentrations may be helpful in preoperative risk stratification.
多项研究评估了术前 B 型利钠肽（NPs）预测手术后死亡率的能力；然而，每项研究中的死亡人数较少，限制了这些研究的效力。我们对术前 NP 水平预测心脏和非心脏手术后死亡率的研究进行了系统评价和荟萃分析。
我们使用了“利钠肽”、“手术或外科手术”和经过验证的预后和诊断术语组合等术语，在 MEDLINE 和 EMBASE 中进行了搜索。两名研究人员独立评估了研究的入选标准并提取了数据。终点是≥6 个月和≤90 天的全因死亡率。我们使用双变量模型得出预后准确性及其异质性的度量标准。我们通过贝叶斯马尔可夫链蒙特卡罗方法计算了汇总阳性预测值（PPV）和阴性预测值（NPV）。
在检索到的 1558 篇文章中，有 23 项研究符合预先设定的入选标准。心脏手术后，NP 预测≥6 个月死亡率的诊断优势比为 4.11（95%置信区间，2.22-7.60），PPV 为 0.17（95%贝叶斯置信区间，0.07-0.36），NPV 为 0.96（0.90-0.98）。非心脏手术后，NP 预测≥6 个月死亡率的诊断优势比为 4.97（3.06-8.07）。相应的 PPV 为 0.24（0.14-0.38），NPV 为 0.94（0.88-0.97）。90 天死亡率的结果相似。
术前 NP 浓度与心脏和非心脏手术后的死亡率相关。NP 对两种类型的手术均具有较高的 NPV，这表明术前 NP 浓度可能有助于术前风险分层。
