Nordling Pauliina, Kiviniemi Tuomas, Strandberg Marjatta, Strandberg Niko, Airaksinen Juhani
Heart Center, Turku University Hospital and Department of Clinical Medicine, University of Turku, Turku, Finland.
Department of Orthopedic Surgery, Turku University Hospital, Turku, Finland.
BMJ Open. 2016 Feb 24;6(2):e009416. doi: 10.1136/bmjopen-2015-009416.
To examine the prognostic value of perioperative N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in hip fracture patients.
Blinded prospective cohort study.
Single centre trial at Turku University Hospital in Finland.
Inclusion criterion was admittance to the study hospital due to hip fracture during the trial period of October 2009--May 2010. Exclusion criteria were the patient's refusal and inadequate laboratory tests. The final study population consisted of 182 patients.
NT-proBNP was assessed once during the perioperative period and later if clinically indicated, and troponin T (TnT) and ECG recordings were evaluated repeatedly. The short-term (30-day) and long-term (1000 days) mortalities were studied.
Median (IQR) follow-up time was 3.1 (0.3) years. The median (IQR) NT-proBNP level was 1260 (2298) ng/L in preoperative and 1600 (3971) ng/L in postoperative samples (p=0.001). TnT was elevated in 66 (36%) patients, and was significantly more common in patients with higher NT-proBNP. Patients with high (>2370 ng/L) and intermediate (806-2370 ng/L) NT-proBNP level had significantly higher short-term mortality compared with patients having a low (<806 ng/L) NT-proBNP level (15 vs 11 vs 2%, p=0.04), and the long-term mortality remained higher in these patients (69% vs 49% vs 27%, p<0.001). Intermediate or high NT-proBNP level (HR 7.8, 95% CI 1.03 to 59.14, p<0.05) was the only independent predictor of short-term mortality, while intermediate or high NT-proBNP level (HR 2.27, 95% CI 1.30 to 3.96, p=0.004), the presence of dementia (HR 1.74, 95% CI 1.13 to 2.66, p=0.01) and higher preoperative American Society of Anesthesiologists' (ASA) classification (HR 1.59, 95% CI 1.06 to 2.38, p=0.02) were independent predictors of long-term mortality.
An elevated perioperative NT-proBNP level is common in hip fracture patients, and it is an independent predictor of short-term and long-term mortality superior to the commonly used clinical risk scores.
NCT01015105; Results.
探讨围手术期脑钠肽前体N端片段（NT-proBNP）对髋部骨折患者的预后价值。
盲法前瞻性队列研究。
芬兰图尔库大学医院的单中心试验。
纳入标准为在2009年10月至2010年5月试验期间因髋部骨折入住研究医院。排除标准为患者拒绝和实验室检查不充分。最终研究人群包括182例患者。
围手术期评估一次NT-proBNP，如有临床指征则随后再次评估，重复评估肌钙蛋白T（TnT）和心电图记录。研究短期（30天）和长期（1000天）死亡率。
中位（四分位间距）随访时间为3.1（0.3）年。术前样本中NT-proBNP水平的中位数（四分位间距）为1260（2298）ng/L，术后样本中为1600（3971）ng/L（p=0.001）。66例（36%）患者TnT升高，在NT-proBNP水平较高的患者中更常见。NT-proBNP水平高（>2370 ng/L）和中等（806 - 2370 ng/L）的患者与NT-proBNP水平低（<806 ng/L）的患者相比，短期死亡率显著更高（15%对11%对2%，p=0.04），这些患者的长期死亡率仍然更高（69%对49%对27%，p<0.001）。中等或高NT-proBNP水平（风险比7.8，95%置信区间1.03至59.14，p<0.05）是短期死亡率的唯一独立预测因素，而中等或高NT-proBNP水平（风险比2.27，95%置信区间1.30至3.96，p=0.004）、痴呆的存在（风险比1.74，95%置信区间1.13至2.66，p=0.01）以及术前美国麻醉医师协会（ASA）分级较高（风险比1.59，95%置信区间1.06至2.38，p=0.02）是长期死亡率的独立预测因素。
围手术期NT-proBNP水平升高在髋部骨折患者中常见，并且是短期和长期死亡率的独立预测因素，优于常用的临床风险评分。
NCT01015105；结果
