Serum N-terminal Pro-B-type Natriuretic Peptide Predicts Mortality in Cardiac Surgery Patients Receiving Renal Replacement Therapy
Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful cardiac biomarker that is associated with acute kidney injury (AKI) and mortality after cardiac surgery. However, its prognostic value in cardiac surgical patients receiving renal replacement therapy (RRT) remains unclear....
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Frontiers Media S.A.
2020-05-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fmed.2020.00153/full |
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| author | Ying Su Jun-yi Hou Yi-jie Zhang Guo-guang Ma Guang-wei Hao Jing-chao Luo Zhe Luo Zhe Luo Guo-wei Tu |
| author_facet | Ying Su Jun-yi Hou Yi-jie Zhang Guo-guang Ma Guang-wei Hao Jing-chao Luo Zhe Luo Zhe Luo Guo-wei Tu |
| author_sort | Ying Su |
| collection | DOAJ |
| description | Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful cardiac biomarker that is associated with acute kidney injury (AKI) and mortality after cardiac surgery. However, its prognostic value in cardiac surgical patients receiving renal replacement therapy (RRT) remains unclear.Objectives: Our study aimed to assess the prognostic value of NT-proBNP in patients with established AKI receiving RRT after cardiac surgery.Methods: A total of 163 cardiac surgical patients with AKI requiring RRT were enrolled in this study. Baseline characteristics, hemodynamic variables at RRT initiation, and NT-proBNP level before surgery, at RRT initiation, and on the first day after RRT were collected. The primary outcome was 28-day mortality after RRT initiation.Results: Serum NT-proBNP levels in non-survivors was markedly higher than survivors before surgery (median: 4,096 [IQR, 962.0–9583.8] vs. 1,339 [IQR, 446–5,173] pg/mL; P < 0.01), at RRT initiation (median: 10,366 [IQR, 5,668–20,646] vs. 3,779 [IQR, 1,799–11,256] pg/mL; P < 0.001), and on the first day after RRT (median: 9,055.0 [IQR, 4,392–24,348] vs. 5,255 [IQR, 2,134–9,175] pg/mL; P < 0.001). The area under the receiver operating characteristic curve of NT-proBNP before surgery, at RRT initiation, and on the first day after RRT for predicting 28-day mortality was 0.64 (95% CI, 0.55–0.73), 0.71 (95% CI, 0.63–0.79), and 0.68 (95% CI, 0.60–0.76), respectively. Consistently, Cox regression revealed that NT-proBNP levels before surgery (HR: 1.27, 95% CI, 1.06–1.52), at RRT initiation (HR: 1.11, 95% CI, 1.06–1.17), and on the first day after RRT (HR: 1.17, 95% CI, 1.11–1.23) were independently associated with 28-day mortality.Conclusions: Serum NT-proBNP was an independent predictor of 28-day mortality in cardiac surgical patients with AKI requiring RRT. The prognostic role of NT-proBNP needs to be confirmed in the future. |
| first_indexed | 2024-12-10T09:40:32Z |
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| id | doaj.art-b1372d085b0b4a4083de2d969364a133 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-10T09:40:32Z |
| publishDate | 2020-05-01 |
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| series | Frontiers in Medicine |
| spelling | doaj.art-b1372d085b0b4a4083de2d969364a1332022-12-22T01:54:00ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2020-05-01710.3389/fmed.2020.00153528968Serum N-terminal Pro-B-type Natriuretic Peptide Predicts Mortality in Cardiac Surgery Patients Receiving Renal Replacement TherapyYing Su0Jun-yi Hou1Yi-jie Zhang2Guo-guang Ma3Guang-wei Hao4Jing-chao Luo5Zhe Luo6Zhe Luo7Guo-wei Tu8Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, ChinaDepartment of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, ChinaBackground: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful cardiac biomarker that is associated with acute kidney injury (AKI) and mortality after cardiac surgery. However, its prognostic value in cardiac surgical patients receiving renal replacement therapy (RRT) remains unclear.Objectives: Our study aimed to assess the prognostic value of NT-proBNP in patients with established AKI receiving RRT after cardiac surgery.Methods: A total of 163 cardiac surgical patients with AKI requiring RRT were enrolled in this study. Baseline characteristics, hemodynamic variables at RRT initiation, and NT-proBNP level before surgery, at RRT initiation, and on the first day after RRT were collected. The primary outcome was 28-day mortality after RRT initiation.Results: Serum NT-proBNP levels in non-survivors was markedly higher than survivors before surgery (median: 4,096 [IQR, 962.0–9583.8] vs. 1,339 [IQR, 446–5,173] pg/mL; P < 0.01), at RRT initiation (median: 10,366 [IQR, 5,668–20,646] vs. 3,779 [IQR, 1,799–11,256] pg/mL; P < 0.001), and on the first day after RRT (median: 9,055.0 [IQR, 4,392–24,348] vs. 5,255 [IQR, 2,134–9,175] pg/mL; P < 0.001). The area under the receiver operating characteristic curve of NT-proBNP before surgery, at RRT initiation, and on the first day after RRT for predicting 28-day mortality was 0.64 (95% CI, 0.55–0.73), 0.71 (95% CI, 0.63–0.79), and 0.68 (95% CI, 0.60–0.76), respectively. Consistently, Cox regression revealed that NT-proBNP levels before surgery (HR: 1.27, 95% CI, 1.06–1.52), at RRT initiation (HR: 1.11, 95% CI, 1.06–1.17), and on the first day after RRT (HR: 1.17, 95% CI, 1.11–1.23) were independently associated with 28-day mortality.Conclusions: Serum NT-proBNP was an independent predictor of 28-day mortality in cardiac surgical patients with AKI requiring RRT. The prognostic role of NT-proBNP needs to be confirmed in the future.https://www.frontiersin.org/article/10.3389/fmed.2020.00153/fullacute kidney injuryrenal replacement therapybiomarkerN-terminal pro-B-type natriuretic peptidemortality |
| spellingShingle | Ying Su Jun-yi Hou Yi-jie Zhang Guo-guang Ma Guang-wei Hao Jing-chao Luo Zhe Luo Zhe Luo Guo-wei Tu Serum N-terminal Pro-B-type Natriuretic Peptide Predicts Mortality in Cardiac Surgery Patients Receiving Renal Replacement Therapy Frontiers in Medicine acute kidney injury renal replacement therapy biomarker N-terminal pro-B-type natriuretic peptide mortality |
| title | Serum N-terminal Pro-B-type Natriuretic Peptide Predicts Mortality in Cardiac Surgery Patients Receiving Renal Replacement Therapy |
| title_full | Serum N-terminal Pro-B-type Natriuretic Peptide Predicts Mortality in Cardiac Surgery Patients Receiving Renal Replacement Therapy |
| title_fullStr | Serum N-terminal Pro-B-type Natriuretic Peptide Predicts Mortality in Cardiac Surgery Patients Receiving Renal Replacement Therapy |
| title_full_unstemmed | Serum N-terminal Pro-B-type Natriuretic Peptide Predicts Mortality in Cardiac Surgery Patients Receiving Renal Replacement Therapy |
| title_short | Serum N-terminal Pro-B-type Natriuretic Peptide Predicts Mortality in Cardiac Surgery Patients Receiving Renal Replacement Therapy |
| title_sort | serum n terminal pro b type natriuretic peptide predicts mortality in cardiac surgery patients receiving renal replacement therapy |
| topic | acute kidney injury renal replacement therapy biomarker N-terminal pro-B-type natriuretic peptide mortality |
| url | https://www.frontiersin.org/article/10.3389/fmed.2020.00153/full |
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