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Preoperative B-type natriuretic peptide, and not the inflammation status, predicts an adverse outcome for patients
Fernando Ganem1, Carlos V Serrano, Juliano L Fernandes
1Heart Institute (InCor), Medical School, University of Säo Paulo, Säo Paulo, Brazil.
Insights
B-type natriuretic peptide (BNP) levels, not inflammatory markers, predict early outcomes after heart surgery. Elevated preoperative BNP indicates longer intensive care unit stays and ventilator use, aiding in predicting patient recovery post-cardiac surgery with cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Biomarkers
- Critical Care Medicine
Background:
- B-type natriuretic peptide (BNP) and inflammatory markers are key in ischemic cardiomyopathy and cardiac surgery complications.
- Cardiopulmonary bypass (CPB) is a common procedure in cardiac surgery.
Purpose of the Study:
- To assess preoperative and postoperative levels of BNP and inflammatory markers (IL-6, IL-8, P-selectin, ICAM, CRP).
- To investigate the correlation of these markers with immediate outcomes after cardiac surgery with CPB.
Main Methods:
- Plasma levels of BNP and inflammatory markers were measured in 62 patients preoperatively, and 6 and 24 hours after CPB.
- Key endpoints included need for intra-aortic balloon pump, prolonged ICU stay (>5 days), ventilator dependence (>24 hours), dobutamine use, prolonged hospital stay (>10 days), clinical complications, and in-hospital mortality.
Main Results:
- Preoperative BNP levels correlated with longer ICU stay, ventilator use, and dobutamine duration.
- BNP levels >190 pg/ml predicted ICU stay >5 days, and >20.5 pg/ml predicted dobutamine use.
- Preoperative ICAM-1 levels were associated with in-hospital mortality.
- Postoperative CRP, IL-6, and P-selectin correlated with ventilation duration, and P-selectin with ICU stay.
Conclusions:
- BNP levels correlate more strongly with clinical outcomes than inflammatory markers after cardiac surgery.
- BNP serves as a valuable predictor of early patient outcomes following heart surgery involving CPB.
Objectives:
B-type natriuretic peptide (BNP) and inflammatory markers are implicated in the pathophysiology of both ischemic cardiomyopathy and complications after cardiac surgery with cardiopulmonary bypass (CPB). The purpose of this study was to assess preoperative and postoperative levels of BNP, interleukin-6 (IL-6), interleukin-8 (IL-8), P-selectin, intercellular adhesion molecule (ICAM), C-reactive protein (CRP) in patients undergoing cardiac surgery with CPB and investigate their variation and ability to correlate with immediate outcome.
Methods:
Plasma levels of these markers were measured preoperatively, 6 and 24 h after CBP in 62 patients. Main endpoints were requirements for intra-aortic balloon pump, intensive care unit (ICU) stay longer than five days, ventilator dependence >24 h, requirement for dobutamine, hospital stay >10 days, clinical complications (infection, myocardial infarction, renal failure, stroke and ventricular arrhythmias) and in-hospital mortality.
Results:
Preoperative BNP levels correlate with longer ICU stay (P = 0.003), longer ventilator use (P = 0.018) and duration of dobutamine use (P < 0.001). The receiver-operating characteristic curve demonstrated BNP levels >190 pg/ml as predictor of ICU >5 days and BNP levels >20.5 pg/ml correlated with dobutamine use, with areas under the curve of 0.712 and 0.842, respectively. Preoperative levels of ICAM-1 were associated with in-hospital mortality (P = 0.042). In the postoperative period, was found association between CRP, IL-6 and P-selectin with ventilation duration (P = 0.013, P = 0.006, P < 0.001, respectively) and P-selectin with ICU stay (P = 0.009).
Conclusions:
BNP correlates with clinical endpoints more than inflammatory markers and can be used as a predictor of early outcome after heart surgery.
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