Perioperative Research Group, Department of Anaesthetics, Grey's Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa; Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.
Perioperative Research Group, Department of Anaesthetics, Grey's Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
J Am Coll Cardiol. 2014 Jan 21;63(2):170-80. doi: 10.1016/j.jacc.2013.08.1630. Epub 2013 Sep 26.
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.
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.
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.
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.
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.
本研究旨在确定在已测量术前 B 型利钠肽（NPs）（即 B 型利钠肽[BNP]和前体 BNP 的 N 末端片段[NT-proBNP]）的非心脏手术成年患者中，测量术后 B 型利钠肽（NPs）是否可以增强风险分层。
术前 NP 浓度是围手术期心血管并发症的有力独立预测因子，但最近的研究报告称，术后 NP 浓度升高与这些并发症独立相关。目前尚不清楚在进行术前测量后测量术后 NP 是否有价值。
我们进行了系统评价和个体患者数据荟萃分析，以确定术后 NP 水平的增加是否增强了术后 30 天和≥180 天死亡和非致命性心肌梗死复合终点的预测。
18 项符合条件的研究提供了个体患者数据（n=2179）。将术后 NP 添加到包含术前 NP 的风险预测模型中，可以改善模型拟合度和 30 天（校正独立性模型准则下的拟似然比：1280 至 1204；净再分类指数：20%；p<0.001）和≥180 天（校正独立性模型准则下的拟似然比：1320 至 1300；净再分类指数：11%；p=0.003）的风险分类。术后 NP 升高是术后 30 天（优势比：3.7；95%置信区间：2.2 至 6.2；p<0.001）和≥180 天（优势比：2.2；95%置信区间：1.9 至 2.7；p<0.001）主要结局的最强独立预测因子。
与单独术前 NP 测量相比，术后 NP 测量可增强非心脏手术后 30 天和≥180 天死亡或非致命性心肌梗死复合结局的风险分层。
