Department of Cardiac Anaesthesia and Postoperative Intensive Care, Medical University of Silesia, Katowice-Ochojec, Poland.
Kardiol Pol. 2011;69(11):1121-7.
B-type natriuretic peptides (BNP) are acknowledged markers of acute and chronic heart failure. Insufficient data exist, however, regarding their diagnostic usefulness in cardiac surgery, particularly in coronary patients.
To assess diagnostic accuracy of preoperative value of NT-proBNP level as a predictor of short-term postoperative complications in subjects undergoing coronary artery bypass grafting (CABG).
This pilot study included 100 consecutive patients scheduled for elective CABG, including 24 females and 76 males (mean age 65.9 ± 9.1 years). Exclusion criteria were: significant valvular disorders, off-pump procedure, renal failure (GFR < 60 mL/min/1.73 m2), low ejection fraction (< 30%), intra-aortic balloon pump counterpulsation (IABP), use of inotropic agents, atrial fibrillation (AF), and implanted pacemaker or defibrillator. The NT-proBNP level was measured on the day of the surgery before induction of anaesthesia. We investigated short-term postoperative complications, defined as those occurring within 30 days or before hospital discharge.
Median NT-proBNP concentration was 526.0 pg/mL (IQR 156.0-1150.0). None of patients died postoperatively. Excessive drainage (> 850 mL) was found in 13 (13%) patients and 22 (22%) subjects required transfusions. Prolonged mechanical ventilation (> 12 h) was necessary in 15 (15%) patients and respiratory failure occurred in 2 (2%) of them. Postoperative AF was present in 34 (34%) subjects. Perioperative myocardial infarction was diagnosed in 2 (2%) persons. Low cardiac output was present in 9 (9%) patients. Haemodynamic support with the use of IABP was necessary in 7 (7%) patients and inotropic drugs were used in 61 (61%) subjects. Stroke or delirium was diagnosed in 1 (1%) subject. The NT-proBNP level correlated with the operative risk estimated by logistic and additive EuroSCORE: r = 0.558 (95% CI 0.406-0.680; p < 0.001) and r = 0.551 (95% CI 0.397-0.674; p < 0.001), respectively. The NT-proBNP level correlated significantly with the length of Intensive Care Unit (ICU) stay and hospital stay: r = 0.412 (95% CI 0.238-0.566; p < 0.001) and r = 0.547 (95% CI 0.393-0.672; p < 0.001), respectively. The NT-proBNP level was a predictor of postoperative prolonged mechanical ventilation, respiratory failure, AF, IABP use, inotropic support and postoperative platelet transfusions (p < 0.05 for all). However, good or very good diagnostic accuracy was found only in relation to mechanical ventilation (AUROC = 0.854), respiratory insufficiency (AUROC = 0.867), IABP use (AUROC = 0.889), and milrinone use (AUROC = 0.929).
Preoperative assessment of NT-proBNP level in CABG patients could be a valuable diagnostic method for predicting several postoperative complications, especially pulmonary outcomes and requirement for haemodynamic support, and it correlated with the length of ICU stay and hospital stay.
B 型利钠肽（BNP）是公认的急性和慢性心力衰竭标志物。然而，关于其在心脏手术中的诊断价值，特别是在冠心病患者中的应用，目前数据有限。
评估术前 NT-proBNP 水平作为预测冠状动脉旁路移植术（CABG）患者短期术后并发症的预测因子的诊断准确性。
这项初步研究纳入了 100 例择期 CABG 的连续患者，包括 24 名女性和 76 名男性（平均年龄 65.9 ± 9.1 岁）。排除标准为：严重瓣膜疾病、非体外循环手术、肾功能衰竭（GFR < 60 mL/min/1.73 m2）、射血分数低（< 30%）、主动脉内球囊反搏（IABP）、使用正性肌力药物、心房颤动（AF）、植入式起搏器或除颤器。在诱导麻醉前一天测量 NT-proBNP 水平。我们研究了短期术后并发症，定义为术后 30 天内或出院前发生的并发症。
中位 NT-proBNP 浓度为 526.0 pg/mL（IQR 156.0-1150.0）。术后无患者死亡。13 例（13%）患者引流过多（> 850 mL），22 例（22%）患者需要输血。15 例（15%）患者需要长时间机械通气（> 12 小时），其中 2 例（2%）患者发生呼吸衰竭。34 例（34%）患者出现术后 AF。2 例（2%）患者诊断为围术期心肌梗死。9 例（9%）患者出现心输出量降低。7 例（7%）患者需要使用 IABP 进行血液动力学支持，61 例（61%）患者使用正性肌力药物。1 例（1%）患者诊断为中风或谵妄。NT-proBNP 水平与通过逻辑和加性 EuroSCORE 估计的手术风险相关：r = 0.558（95%CI 0.406-0.680；p < 0.001）和 r = 0.551（95%CI 0.397-0.674；p < 0.001）。NT-proBNP 水平与 ICU 住院时间和住院时间显著相关：r = 0.412（95%CI 0.238-0.566；p < 0.001）和 r = 0.547（95%CI 0.393-0.672；p < 0.001）。NT-proBNP 水平是术后机械通气延长、呼吸衰竭、AF、IABP 使用、正性肌力支持和术后血小板输注的预测因子（p < 0.05）。然而，仅在与机械通气（AUROC = 0.854）、呼吸衰竭（AUROC = 0.867）、IABP 使用（AUROC = 0.889）和米力农使用（AUROC = 0.929）相关时，才发现其具有良好或极好的诊断准确性。
CABG 患者术前评估 NT-proBNP 水平可能是一种有价值的诊断方法，可预测多种术后并发症，特别是肺部结局和对血液动力学支持的需求，并且与 ICU 住院时间和住院时间相关。
