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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

View larger version (65K): [in a new window]   Figure 1 Preoperative B-type natriuretic peptide (BNP) levels in patients with and without particular end points (use of an intra-aortic balloon pump [IABP], mortality [Mort] within one year, and postoperative hospital duration of stay [POD] of 10 days or more). *p = 0.015; **p = 0.034; ***p = 0.049.

View larger version (24K): [in a new window]   Figure 2 Receiver operating characteristic curves: preoperative B-type natriuretic peptide (BNP) levels to use of an (A) intra-aortic balloon pump, (B) postoperative hospital stay of 10 days or more, and (C) one-year mortality.

View larger version (21K): [in a new window]   Figure 3 Receiver operating characteristic: change to maximum B-type natriuretic peptide (BNP) in patients with prolonged hospitalization (10 days) or death within one year. AUC = area under the curve.

View larger version (15K): [in a new window]   Figure 4 (A) Highest postoperative B-type natriuretic peptide (BNP) levels in patients that were alive and group that were deceased within one year. p = 0.007. (B) Highest postoperative BNP levels in patients that were hospitalized up to 10 days, and patients that had prolonged hospital stay (10 days) after open-heart surgery. p = 0.0001. The ends of the whiskers show the position of the minimum and maximum of the data, whereas the edges and line in center of the box show the upper and lower quartiles and the median. The whiskers show at a glance the behavior of the extreme outliers, whereas the box edges and midline summarize the sample in a resistant manner. Strong asymmetry in the box midline and edges suggests that the distribution is skewed and can be quantified using the Yule-Kendall skewness statistic.