Zhang Li-Jun, Li Na, Li Yang, Zeng Xian-Tao, Liu Mei-Yan
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
Front Physiol. 2019 Jan 18;9:1923. doi: 10.3389/fphys.2018.01923. eCollection 2018.
The present meta-analysis was aimed to systematically evaluate the effectiveness and accuracy of brain natriuretic peptide (BNP), cardiac troponin (cTn), high sensitive C reactive protein (hs-CRP) and CRP for predicting postoperative major adverse cardiovascular events (MACE) in patients undergoing noncardiac surgery. A total of 26 relevant studies with 7,877 participants were collected from five databases, namely PubMed, Embase, China National Knowledge Infrastructure (CNKI), CQVIP and the Wanfang Database until August 10, 2018. And the Review Manager Version 5.3 and Stata/SE 12 software were used for data syntheses in the meta-analysis. Strong relationships of BNP/NT-proBNP, cTnI/cTnT and hs-CRP with MACE were detected in patients undergoing noncardiac surgery, and the five biomarkers all increased the risk of MACE. Compared to normal levels, elevated BNP/NT-proBNP could increase the MACE risk by almost 4-fold [RR:3.92, 95%CI: 3.23-4.75, < 0.001]; elevated BNP corresponded to a 4.5-fold risk [RR:4.57, 95%CI: 3.37-6.20, < 0.001]; elevated NT-proBNP led to a 3-fold higher risk [RR:3.48, 95%CI: 2.71-4.46, < 0.001]. Comparing with normal levels of cTnI/cTnT, increased cTnI/cTnT was associated with nearly 5-fold more higher risk of MACE [RR:5.52, 95%CI: 4.62-6.58, < 0.001]; elevated cTnI faced a 5-fold risk [RR:5.21, 95%CI: 3.96-6.86, < 0.001]; elevated cTnT resulted in nearly 6-fold higher risk [RR:5.73, 95%CI: 4.55-7.22, < 0.001]. The elevation of hs-CRP was associated with nearly 4-fold higher risk of MACE in comparison with normal concentration [RR:3.73, 95%CI: 2.63-5.30, < 0.001]. According to the results of our meta-analysis, the elevations of BNP/NT-proBNP, cTnI/cTnT, and hs-CRP, pre-operation or post-operation immediately, can predict much higher risk of postoperative MACE in patients undergoing noncardiac surgery.
本荟萃分析旨在系统评估脑钠肽（BNP）、心肌肌钙蛋白（cTn）、高敏C反应蛋白（hs-CRP）和C反应蛋白（CRP）预测非心脏手术患者术后主要不良心血管事件（MACE）的有效性和准确性。截至2018年8月10日，从五个数据库，即PubMed、Embase、中国知网（CNKI）、维普资讯和万方数据库中收集了26项相关研究，共7877名参与者。在荟萃分析中，使用Review Manager 5.3版和Stata/SE 12软件进行数据合成。在接受非心脏手术的患者中，检测到BNP/NT-proBNP、cTnI/cTnT和hs-CRP与MACE之间存在密切关系，这五种生物标志物均增加了MACE的风险。与正常水平相比，BNP/NT-proBNP升高可使MACE风险增加近4倍[风险比（RR）：3.92，95%置信区间（CI）：3.23 - 4.75，P < 0.001]；BNP升高对应的风险为4.5倍[RR：4.57，95%CI：3.37 - 6.20，P < 0.001]；NT-proBNP升高导致风险高出3倍[RR：3.48，95%CI：2.71 - 4.46，P < 0.001]。与cTnI/cTnT正常水平相比，cTnI/cTnT升高与MACE风险高出近5倍相关[RR：5.52，95%CI：4.62 - 6.58，P < 0.001]；cTnI升高面临5倍风险[RR：5.21，95%CI：3.96 - 6.86，P < 0.001]；cTnT升高导致风险高出近6倍[RR：5.73，95%CI：4.55 - 7.22，P < 0.001]。与正常浓度相比，hs-CRP升高与MACE风险高出近4倍相关[RR：3.73，95%CI：2.63 - 5.30，P < 0.001]。根据我们的荟萃分析结果，术前或术后立即出现的BNP/NT-proBNP、cTnI/cTnT和hs-CRP升高可预测非心脏手术患者术后MACE的风险高得多。
