Katsanos Spyridon, Babalis Dimitrios, Kafkas Nikolaos, Mavrogenis Andreas, Leong Darryl, Parissis John, Varounis Christos, Makris Konstantinos, van der Heijden Aafke, Anastasiou-Nana Maria, Filippatos Gerasimos
aDepartment of Cardiology, KAT General Hospital bDepartment of Orthopaedic, ATTIKON University Hospital, Athens, Greece cDiscipline of Medicine, Flinders University and University of Adelaide, Adelaide, Australia dDepartment of Cardiology, ATTIKON University Hospital eDepartment of Biochemistry, KAT General Hospital, Athens, Greece fDepartment of Cardiology, Leiden University Medical Center, The Netherlands.
J Cardiovasc Med (Hagerstown). 2015 Jun;16(6):465-71. doi: 10.2459/JCM.0000000000000210.
The clinical role of B-type natriuretic peptide (BNP) in preoperative evaluation is not clear. We designed a prospective study to investigate the predictive value of BNP in comparison with established clinical risk scores for the outcome of major orthopedic surgery.
Overall 242 elderly patients [80 (74-85) years] undergoing orthopedic surgery were included. Inhospital cardiovascular events and 1-year mortality were the main endpoints.
In total 20 (8.3%) patients had major cardiovascular events (MACE) and 41 (21.1%) died in 1 year. Logistic regression analysis for prediction of cardiac events and 1-year mortality, respectively, revealed a significant prognostic value for the BNP (P < 0.001 and P = 0.041), Goldman (P = 0.013 and P = 0.003), Lee (P = 0.022 and P = 0.200), Detsky (P < 0.001 and P < 0.001), and functional capacity indices (P = 0.034 and P = 0.001). BNP cutoff 149 ng/ml improved discrimination of all scores to predict MACE, and BNP cutoff 89 ng/ml improved discrimination of all scores to predict 1-year mortality (Net Reclassification Improvement, P values < 0.05 in all cases). Age [hazard ratio (HR): 1.100, 95% confidence interval (CI): 1.039-1.166, P = 0.001] and BNP (HR: 1.002, 95% CI: 1.000-1.003, P = 0.041) were independent associates of 1-year mortality.
Preoperative levels of BNP compare favorably with the Goldman, Lee, Detsky, and functional capacity indices for prognosis of orthopedic surgery. Implementation of natriuretic peptides in cardiac risk scores is promising.
B型利钠肽（BNP）在术前评估中的临床作用尚不清楚。我们设计了一项前瞻性研究，以调查BNP与既定临床风险评分相比对骨科大手术结局的预测价值。
共纳入242例接受骨科手术的老年患者[80（74 - 85）岁]。住院期间心血管事件和1年死亡率为主要终点。
共有20例（8.3%）患者发生主要心血管事件（MACE），41例（21.1%）在1年内死亡。分别对心脏事件和1年死亡率进行逻辑回归分析，结果显示BNP（P<0.001和P = 0.041）、Goldman评分（P = 0.013和P = 0.003）、Lee评分（P = 0.022和P = 0.200）、Detsky评分（P<0.001和P<0.001）以及功能能力指标（P = 0.034和P = 0.001）具有显著的预后价值。BNP临界值149 ng/ml可提高所有评分对MACE的预测辨别力，BNP临界值89 ng/ml可提高所有评分对1年死亡率的预测辨别力（净重新分类改善，所有情况下P值<0.05）。年龄[风险比（HR）：1.100，95%置信区间（CI）：1.039 - 1.166，P = 0.001]和BNP（HR：1.002，95%CI：1.000 - 1.003，P = 0.041）是1年死亡率的独立相关因素。
术前BNP水平在骨科手术预后方面与Goldman、Lee、Detsky评分及功能能力指标相比具有优势。将利钠肽纳入心脏风险评分具有前景。
