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 .

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 organization: Anestesiologian yksikkö
HUS Perioperative, Intensive Care and Pain Medicine
Department of Diagnostics and Therapeutics
HUS Emergency Medicine and Services
University of Helsinki
Date: 2018-03
Language: eng
Number of pages: 7
Belongs to series: Clinical Biochemistry
ISSN: 0009-9120
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
Risk assessment
3111 Biomedicine
3121 General medicine, internal medicine and other clinical medicine
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: publishedVersion

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