The interrelationship between preoperative anemia and N-terminal pro-B-type natriuretic peptide: the effect on predicting postoperative cardiac outcome in vascular surgery patients.

Full Abstract

INTRODUCTION: N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts adverse cardiac outcome in patients undergoing vascular surgery. However, several conditions might influence this prognostic value, including anemia. In this study, we evaluated whether anemia confounds the prognostic value of NT-proBNP for predicting cardiac events in patients undergoing vascular surgery. METHODS: A detailed cardiac history, resting echocardiography, and hemoglobin and NT-proBNP levels were obtained in 666 patients before vascular surgery. Anemia was defined as serum hemoglobin <13 g/dL for men and <12 g/dL for women. Troponin T measurements and 12-lead electrocardiograms were performed on postoperative days 1, 3, 7, and 30 and whenever clinically indicated. The primary end point of the study was the composite of 30-day postoperative cardiovascular death, nonfatal myocardial infarction, and troponin T release. Receiver operating characteristic curve analysis was used to assess the optimal cutoff value of NT-proBNP for the prediction of the composite end point. Multivariable regression analysis was used to assess the additional value of NT-proBNP for the prediction of postoperative cardiac events in nonanemic and anemic patients. RESULTS: Anemia was present in 206 patients (31%) before surgery. Hemoglobin level was inversely related with the NT-proBNP levels (beta coefficient = -2.242; P = 0.025). The optimal predictive cutoff value of NT-proBNP for predicting the composite cardiovascular outcome was 350 pg/mL. After adjustment for clinical cardiac risk factors, both anemia (odds ratio [OR] 1.53; 95% confidence interval [CI]: 1.07-2.99) and increased levels of NT-proBNP (OR 4.09; 95% CI: 2.19-7.64) remained independent predictors for postoperative cardiac events. However, increased levels of NT-proBNP were not predictive for the risk of adverse cardiac events in the subgroup of anemic patients (OR 2.16; 95% CI: 0.90-5.21). CONCLUSIONS: Both anemia and NT-proBNP are independently associated with an increased risk for postoperative cardiac events in patients undergoing vascular surgery. NT-proBNP has less predictive value in anemic patients.

Author information

Author/s: Goei, Dustin (D); Flu, Willem-Jan (WJ); Hoeks, Sanne E (SE); Galal, Wael (W); Dunkelgrun, Martin (M); Boersma, Eric (E); Kuijper, Ruud (R); van Kuijk, Jan-Peter (JP); Winkel, Tamara A (TA); Schouten, Olaf (O); Bax, Jeroen J (JJ); Poldermans, Don (D);

Affiliation: Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Anesthesia and analgesia (Anesth Analg), published in United States. (Language: eng)

Reference: 2009-Nov; vol 109 (issue 5) : pp 1403-8

Dates: Created 2009/10/21; Completed 2009/11/05;

PMID: 19843778, status: MEDLINE (last retrieval date: 11/5/2009, IMS Date: )

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged
Anemia - blood; complications
Biological Markers - blood
Electrocardiography
Female
Heart Diseases - blood; etiology; mortality
Hemoglobins - metabolism
Humans
Linear Models
Male
Middle Aged
Natriuretic Peptide, Brain - blood

Natriuretic Peptide, Brain - blood
Odds Ratio
Peptide Fragments - blood
Predictive Value of Tests
ROC Curve
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Troponin T - blood
Vascular Surgical Procedures - adverse effects; mortality

Associated Chemicals: Biological Markers (0) ; Hemoglobins (0) ; Peptide Fragments (0) ; Troponin T (0) ; pro-brain natriuretic peptide (1-76) (0) ; Natriuretic Peptide, Brain (114471-18-0)

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