A Combination of N-Terminal proB-Type Natriuretic Peptide and Myoglobin Can Predict Severe Complications After Major Non-Cardiac Surgery in Elderly Patients: A Prospective Observational Cohort Study
Background: 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...
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Frontiers Media S.A.
2021-09-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.679260/full |
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| author | Yi Zhao Yi Zhao Xuechao Hao Xuechao Hao Yihao Zhu Yihao Zhu Mingkai Chen Mingkai Chen Mengchan Ou Mengchan Ou Tao Zhu Tao Zhu |
| author_facet | Yi Zhao Yi Zhao Xuechao Hao Xuechao Hao Yihao Zhu Yihao Zhu Mingkai Chen Mingkai Chen Mengchan Ou Mengchan Ou Tao Zhu Tao Zhu |
| author_sort | Yi Zhao |
| collection | DOAJ |
| description | Background: 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).Methods: 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/).Results: 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, P < 0.001; AUC, 0.785; 95% CI: 0.685, 0.885, P < 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, P < 0.001).Conclusions: 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. |
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| spelling | doaj.art-ed7f5b612ec54e84b3c16a6de4d137172022-12-21T21:30:49ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-09-01810.3389/fmed.2021.679260679260A Combination of N-Terminal proB-Type Natriuretic Peptide and Myoglobin Can Predict Severe Complications After Major Non-Cardiac Surgery in Elderly Patients: A Prospective Observational Cohort StudyYi Zhao0Yi Zhao1Xuechao Hao2Xuechao Hao3Yihao Zhu4Yihao Zhu5Mingkai Chen6Mingkai Chen7Mengchan Ou8Mengchan Ou9Tao Zhu10Tao Zhu11Departments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, ChinaThe Research Units of West China-Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, ChinaDepartments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, ChinaThe Research Units of West China-Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, ChinaDepartments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, ChinaThe Research Units of West China-Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, ChinaDepartments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, ChinaThe Research Units of West China-Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, ChinaDepartments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, ChinaThe Research Units of West China-Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, ChinaDepartments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, ChinaThe Research Units of West China-Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, ChinaBackground: 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).Methods: 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/).Results: 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, P < 0.001; AUC, 0.785; 95% CI: 0.685, 0.885, P < 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, P < 0.001).Conclusions: 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.https://www.frontiersin.org/articles/10.3389/fmed.2021.679260/fullNT-pro BNPMYOpostoperative complicationselderly patientsrisk stratification |
| spellingShingle | Yi Zhao Yi Zhao Xuechao Hao Xuechao Hao Yihao Zhu Yihao Zhu Mingkai Chen Mingkai Chen Mengchan Ou Mengchan Ou Tao Zhu Tao Zhu A Combination of N-Terminal proB-Type Natriuretic Peptide and Myoglobin Can Predict Severe Complications After Major Non-Cardiac Surgery in Elderly Patients: A Prospective Observational Cohort Study Frontiers in Medicine NT-pro BNP MYO postoperative complications elderly patients risk stratification |
| title | A Combination of N-Terminal proB-Type Natriuretic Peptide and Myoglobin Can Predict Severe Complications After Major Non-Cardiac Surgery in Elderly Patients: A Prospective Observational Cohort Study |
| title_full | A Combination of N-Terminal proB-Type Natriuretic Peptide and Myoglobin Can Predict Severe Complications After Major Non-Cardiac Surgery in Elderly Patients: A Prospective Observational Cohort Study |
| title_fullStr | A Combination of N-Terminal proB-Type Natriuretic Peptide and Myoglobin Can Predict Severe Complications After Major Non-Cardiac Surgery in Elderly Patients: A Prospective Observational Cohort Study |
| title_full_unstemmed | A Combination of N-Terminal proB-Type Natriuretic Peptide and Myoglobin Can Predict Severe Complications After Major Non-Cardiac Surgery in Elderly Patients: A Prospective Observational Cohort Study |
| title_short | A Combination of N-Terminal proB-Type Natriuretic Peptide and Myoglobin Can Predict Severe Complications After Major Non-Cardiac Surgery in Elderly Patients: A Prospective Observational Cohort Study |
| title_sort | combination of n terminal prob type natriuretic peptide and myoglobin can predict severe complications after major non cardiac surgery in elderly patients a prospective observational cohort study |
| topic | NT-pro BNP MYO postoperative complications elderly patients risk stratification |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.679260/full |
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