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CLINICAL RESEARCH: BIOMARKERS

Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgery

Ryan Hutfless, MD, Radmila Kazanegra, MD^*, Michael Madani, MD^*, Meenakshi Awasthi Bhalla, MD, Alisi Tulua-Tata, BS, Amelia Chen, BS, Paul Clopton, MS^*, Cherimarie James, RN^*, Albert Chiu, BS^* and Alan S. Maisel, MD^*,*

^* Department of Medicine, Division of Cardiology, Department of Surgery, San Diego VA Healthcare System, San Diego, California, USA
University of California, San Diego, San Diego, California, USA
University of Buffalo, Mercy Hospital, Buffalo, New York, USA

Manuscript received October 4, 2003; revised manuscript received December 1, 2003, accepted December 9, 2003.

^* Reprint requests and correspondence: Dr. Alan S. Maisel, VAMC Cardiology 111-A, 3350 La Jolla Village Drive, San Diego, California 92161, USA.
amaisel{at}ucsd.edu

OBJECTIVES: The purpose of the present study was to assess whether preoperative and postoperative B-type natriuretic peptide (BNP) levels could be used as predictors of postoperative complications and outcomes in patients after open-heart surgery.

BACKGROUND: A variety of multifactor indexes have been proposed for preoperative risk assessment of patients undergoing cardiac surgery, but they have shown limited ability and utility in accurately predicting postoperative complications, hospital stay, and mortality.

METHODS: Subjects consisted of 98 male patients (63 ± 9.1 years) undergoing open-heart surgery at the San Diego Veterans Administration Health System during a 19-month period. B-type natriuretic peptide levels were analyzed, and postoperative data recorded.

RESULTS: There was a higher preoperative BNP level in patients requiring the use of intra-aortic balloon pumps (IABPs) (mean BNP = 387 ± 112 pg/ml vs. 181 ± 25 pg/ml), in patients who died within one year (357 ± 93 pg/ml vs. 184 ± 26 pg/ml), and in patients with postoperative hospital stays of 10 days or more (307 ± 68 pg/ml vs. 179 ± 27 pg/ml). Receiver operating characteristic curves demonstrated preoperative BNP levels as predictors of postoperative IABP use, hospital stay 10 days, and mortality <1 year with areas under the curve of 0.70, 0.64, and 0.70, respectively. A BNP cut-off value above 385 pg/ml demonstrated high specificity (=90% in each) and accuracy (=86%, 79%, 85%, respectively) for predicting each of these end points.

CONCLUSIONS: Preoperative BNP levels >385 pg/ml predict the postoperative complications and one-year mortality after heart surgery. Postoperatively, elevated peak BNP levels and elevated change to peak BNP levels were associated with prolonged hospital stay and mortality within one year.

Abbreviations and Acronyms   AUC = area under the curve   BNP = B-type natriuretic peptide   HF = heart failure   IABP = intra-aortic balloon pump   ROC = receiver operating characteristic

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