The Predictive Value of Pre-operative N-Terminal Pro-B-Type Natriuretic Peptide in the Risk of Acute Kidney Injury After Non-cardiac Surgery.

OBJECTIVE

To evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and risk of post-operative acute kidney injury (PO-AKI).

METHODS

The electronic medical records and laboratory results were obtained from 3,949 adult patients (≥18 years) undergoing non-cardiac surgery performed between 1 October 2012 to 1 October 2019 at the Third Xiangya Hospital, Central South University, China. Collected data were analyzed retrospectively.

RESULTS

In all, 5.3% (209 of 3,949) of patients developed PO-AKI. Pre-operative NT-proBNP was an independent predictor of PO-AKI. After adjustment for significant variables, OR for AKI of highest and lowest NT-proBNP quintiles was 1.96 (95% CI, 1.04-3.68, = 0.008), OR per 1-unit increment in natural log transformed NT-proBNP was 1.20 (95% CI, 1.09-1.32, < 0.001). Compared with clinical variables alone, the addition of NT-proBNP modestly improved the discrimination [change in area under the curve(AUC) from 0.82 to 0.83, ΔAUC=0.01, = 0.024] and the reclassification (continuous net reclassification improvement 0.15, 95% CI, 0.01-0.29, = 0.034, improved integrated discrimination 0.01, 95% CI, 0.002-0.02, = 0.017) of AKI and non-AKI cases.

CONCLUSIONS

Results from our retrospective cohort study showed that the addition of pre-operative NT-proBNP concentrations could better predict post-operative AKI in a cohort of non-cardiac surgery patients and achieve higher net benefit in decision curve analysis.