Brynildsen Jon, Petäjä Liisa, Pettilä Ville, Nygård Ståle, Vaara Suvi T, Linko Rita, Okkonen Marjatta, Hagve Tor-Arne, Soininen Leena, Suojaranta-Ylinen Raili, Lyngbakken Magnus Nakrem, Omland Torbjørn, Røsjø Helge
Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Clin Biochem. 2018 Mar;53:65-71. doi: 10.1016/j.clinbiochem.2018.01.012. Epub 2018 Jan 31.
European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is used for risk stratification before cardiac surgery, but whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT) may add prognostic information to EuroSCORE II is not known.
Preoperative (n=640) and postoperative (n=629) blood samples were available from cardiac surgical patients with 961-day follow-up (FINNAKI Heart study; cohort #1). The accuracy of a parsimonious risk model with NT-proBNP measurements was also tested in 90 patients with respiratory failure after cardiac surgery (FINNALI study; cohort #2).
Sixty-one patients (9.5%) died during follow-up in cohort #1. Preoperative NT-proBNP and hs-TnT concentrations correlated (rho=0.58; p<0.001) and were higher in non-survivors compared to survivors: median 2027 (Q1-3 478-5387) vs. 373 (134-1354) ng/L [NT-proBNP] and 39 (16-191) vs. 13 (8-32) ng/L [hs-TnT]; p<0.001 for both. Preoperative NT-proBNP concentrations were associated with time to death after adjustment for EuroSCORE II (HR [NT-proBNP] 1.33 [95% CI 1.08-1.64]), p=0.008 and reclassified patients on top of EuroSCORE II (net reclassification index 0.39 [95% CI 0.14-0.64], p=0.003). Pre- and postoperative NT-proBNP concentrations were closely correlated (rho=0.80, p<0.001) and postoperative NT-proBNP concentrations were also associated with long-term mortality after adjustment for EuroSCORE II. A parsimonious risk model that included age, creatinine clearance, chronic pulmonary disease, and NT-proBNP measurements provided comparable prognostic accuracy as EuroSCORE II in cohort #1 and #2 for risk of long-term mortality. hs-TnT measurements did not add to NT-proBNP measurements CONCLUSION: NT-proBNP measurements could improve and simplify risk prediction in cardiac surgical patients.
欧洲心脏手术风险评估系统II（EuroSCORE II）用于心脏手术前的风险分层，但N端前脑钠肽（NT-proBNP）和高敏肌钙蛋白T（hs-TnT）是否能为EuroSCORE II增添预后信息尚不清楚。
有心脏手术患者术前（n = 640）和术后（n = 629）的血样，随访961天（芬兰心脏研究；队列#1）。还在90例心脏手术后呼吸衰竭患者中测试了含NT-proBNP测量值的简约风险模型的准确性（FINNALI研究；队列#2）。
队列#1中有61例患者（9.5%）在随访期间死亡。术前NT-proBNP和hs-TnT浓度相关（rho = 0.58；p < 0.001），与幸存者相比，非幸存者的浓度更高：中位数2027（四分位数间距478 - 5387）对373（134 - 1354）ng/L [NT-proBNP]，以及39（16 - 191）对13（8 - 32）ng/L [hs-TnT]；两者p均< 0.001。校正EuroSCORE II后，术前NT-proBNP浓度与死亡时间相关（HR [NT-proBNP] 1.33 [95% CI 1.08 - 1.64]），p = 0.008，且在EuroSCORE II基础上对患者进行了重新分类（净重新分类指数0.39 [95% CI 0.14 - 0.64]，p = 0.003）。术前和术后NT-proBNP浓度密切相关（rho = 0.80，p < 0.001），校正EuroSCORE II后，术后NT-proBNP浓度也与长期死亡率相关。一个包含年龄、肌酐清除率、慢性肺病和NT-proBNP测量值的简约风险模型在队列#1和#2中对长期死亡风险的预测准确性与EuroSCORE II相当。hs-TnT测量值并未为NT-proBNP测量值增添信息。结论：NT-proBNP测量值可改善并简化心脏手术患者的风险预测。
