The predictive value of NT-proBNP and hs-TnT for risk of death in cardiac surgical patients

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Brynildsen , J , Petäjä , L , Pettilä , V , Nygård , S , Vaara , S T , Linko , R , Okkonen , M , Hagve , T-A , Soininen , L , Suojaranta-Ylinen , R , Lyngbakken , M N , Omland , T & Rosjo , H 2018 , ' The predictive value of NT-proBNP and hs-TnT for risk of death in cardiac surgical patients ' , Clinical Biochemistry , vol. 53 , pp. 65-71 . https://doi.org/10.1016/j.clinbiochem.2018.01.012

Title: The predictive value of NT-proBNP and hs-TnT for risk of death in cardiac surgical patients
Author: Brynildsen, Jon; Petäjä, Liisa; Pettilä, Ville; Nygård, Stale; Vaara, Suvi T.; Linko, Rita; Okkonen, Marjatta; Hagve, Tor-Arne; Soininen, Leena; Suojaranta-Ylinen, Raili; Lyngbakken, Magnus Nakrem; Omland, Torbjorn; Rosjo, Helge
Contributor: University of Helsinki, Anestesiologian yksikkö
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, Clinicum
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, Anestesiologian yksikkö
Date: 2018-03
Language: eng
Number of pages: 7
Belongs to series: Clinical Biochemistry
ISSN: 0009-9120
URI: http://hdl.handle.net/10138/301255
Abstract: Background: European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is used for risk stratification before cardiac surgery, but whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT) may add prognostic information to EuroSCORE II is not known. Methods: Preoperative (n = 640) and postoperative (n = 629) blood samples were available from cardiac surgical patients with 961-day follow-up (FINNAKI Heart study; cohort #1). The accuracy of a parsimonious risk model with NT-proBNP measurements was also tested in 90 patients with respiratory failure after cardiac surgery (FINNALI study; cohort #2). Results: Sixty-one patients (9.5%) died during follow-up in cohort #1. Preoperative NT-proBNP and hs-TnT concentrations correlated (rho = 0.58; p <0.001) and were higher in non-survivors compared to survivors: median 2027 (Q1-3 478-5387) vs. 373 (134-1354) ng/L [NT-proBNP] and 39 (16-191) vs. 13 (8-32) ng/L [hs-TnT]; p <0.001 for both. Preoperative NT-proBNP concentrations were associated with time to death after adjustment for EuroSCORE II (HR [lnNT-proBNP] 1.33 [95% CI 1.08-1.64]), p = 0.008 and reclassified patients on top of EuroSCORE II (net reclassification index 0.39 [95% CI 0.14-0.64], p = 0.003). Pre-and postoperative NT-proBNP concentrations were closely correlated (rho = 0.80, p <0.001) and postoperative NT-proBNP concentrations were also associated with long-term mortality after adjustment for EuroSCORE II. A parsimonious risk model that included age, creatinine clearance, chronic pulmonary disease, and NT-proBNP measurements provided comparable prognostic accuracy as EuroSCORE II in cohort #1 and #2 for risk of long-term mortality. hs-TnT measurements did not add to NT-proBNP measurements Conclusion: NT-proBNP measurements could improve and simplify risk prediction in cardiac surgical patients.
Subject: Biomarkers
Cardiac surgery
Troponin T
NT-proBNP
Risk assessment
SENSITIVITY TROPONIN-T
BYPASS GRAFT-SURGERY
EUROSCORE II
NATRIURETIC PEPTIDE
ORIGINAL EUROSCORE
PROSPECTIVE COHORT
EUROPEAN SYSTEM
FREEZE-THAW
MORTALITY
SOCIETY
3111 Biomedicine
3121 General medicine, internal medicine and other clinical medicine
3126 Surgery, anesthesiology, intensive care, radiology
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