Zhao Yi, Hao Xuechao, Zhu Yihao, Chen Mingkai, Ou Mengchan, Zhu Tao
Departments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.
The Research Units of West China-Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, China.
Front Med (Lausanne). 2021 Sep 27;8:679260. doi: 10.3389/fmed.2021.679260. eCollection 2021.
Previous studies have demonstrated that serum N-terminal proB-type natriuretic peptide (NT-proBNP) was a predictor of adverse cardiovascular outcomes after surgery. We performed a prospective study to evaluate if NT-proBNP could be a sensitive marker of overall postoperative outcomes in older patients undergoing major elective non-cardiac surgery when combined with myoglobin (MYO). Two hundred and three adults aged ≥65 years were enrolled in the study. The American Society of Anesthesiologists (ASA) physical status of patients were I to IV. Blood samples would be taken before and 2 h after the surgery for each patients and NT-proBNP and MYO concentrations (NT-proBNP baseline/ 2 h and MYO baseline/ 2 h) of these samples would be measured immediately. The primary outcome was moderate to severe complications, which were based on the Clavien-Dindo Classification (CDC) scheme (≥CDC grade 3), and the secondary outcomes were major complications within 30 days after surgery. This study was registered at China Clinical Trial Registry (ChiCTR1900026223, http://www.chictr.org.cn/). Overall, moderate to severe complications occurred in 15 patients (7.4%) and major complications occurred in 18 patients (8.9%). Both preoperative and postoperative NT-proBNP values were independent predictors of moderate to severe complications (area under the curve (AUC), 0.820; 95% CI: 0.728, 0.912, < 0.001; AUC, 0.785; 95% CI: 0.685, 0.885, < 0.001). When NT-proBNP baseline and MYO-2 h were combined (NT-proBNP baseline × MYO-2 h), the predictive power was improved (AUC 0.841, 95% CI: 0.758, 0.923, < 0.001). A combination of perioperative NT-proBNP and postoperative MYO concentrations was a good predictor of postoperative complications in elderly patients who underwent major non-cardiac surgery. Using fast and dynamic tests provided by point-to-care-testing, NT-proBNP and MYO concentration measurements provided useful guidance for therapy before or soon after surgery, thus helping to reduce postoperative complications in elderly patients.
既往研究表明，血清N末端B型利钠肽原（NT-proBNP）是术后不良心血管结局的一个预测指标。我们进行了一项前瞻性研究，以评估在接受大型择期非心脏手术的老年患者中，NT-proBNP与肌红蛋白（MYO）联合检测时能否作为总体术后结局的敏感标志物。203名年龄≥65岁的成年人纳入本研究。患者的美国麻醉医师协会（ASA）身体状况分级为I至IV级。对每位患者在术前及术后2小时采集血样，并立即检测这些样本的NT-proBNP和MYO浓度（NT-proBNP基线/术后2小时及MYO基线/术后2小时）。主要结局为中重度并发症，依据Clavien-Dindo分类（CDC）标准（≥CDC 3级），次要结局为术后30天内的严重并发症。本研究在中国临床试验注册中心注册（ChiCTR1900026223，http://www.chictr.org.cn/）。总体而言，15例患者（7.4%）发生中重度并发症，18例患者（8.9%）发生严重并发症。术前及术后NT-proBNP值均为中重度并发症的独立预测指标（曲线下面积（AUC），0.820；95%CI：0.728，0.912，P<0.001；AUC，0.785；95%CI：0.685，0.885，P<0.001）。当NT-proBNP基线与MYO术后2小时联合检测（NT-proBNP基线×MYO术后2小时）时，预测能力得到提高（AUC 0.841，95%CI：0.758，0.923，P<0.001）。围手术期NT-proBNP与术后MYO浓度联合检测是接受大型非心脏手术老年患者术后并发症的良好预测指标。通过即时检验提供的快速动态检测，NT-proBNP和MYO浓度检测为手术前或手术后不久的治疗提供了有用指导，从而有助于减少老年患者的术后并发症。
