Related Experiment Video
Updated: Mar 8, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Does N-terminal Pro-brain Type Natriuretic Peptide Predict Cardiac Complications After Hip Fracture Surgery?
Hiroki Ushirozako1, Tsuyoshi Ohishi2, Tomotada Fujita2
1Department of Orthopaedic Surgery, Fujinomiya City Hospital, 3-1 Nishiki-Cho, Fujinomiya, Shizuoka, 418-0076, Japan. verisa0808@gmail.com.
Insights
A preoperative NT-proBNP level above 600 pg/mL is a strong predictor of cardiac complications in elderly hip fracture patients without renal dysfunction. This biomarker aids in early risk assessment for postoperative cardiac events.
Area of Science:
- Cardiology
- Orthopedic Surgery
- Biomarker Research
Background:
- Elderly hip fracture patients face significant cardiac complication risks.
- N-terminal pro-brain type natriuretic peptide (NT-proBNP) shows predictive value for cardiac issues in surgical settings.
- Limited research exists on NT-proBNP's utility specifically in hip fracture patients, necessitating a refined cutoff value excluding renal dysfunction.
Purpose of the Study:
- To determine the association between preoperative NT-proBNP levels and the incidence of cardiac complications following hip fracture surgery.
- To establish a precise NT-proBNP cutoff value for predicting these complications in a carefully selected patient cohort.
Main Methods:
- A cohort of 328 elderly hip fracture patients (mean age 83) without renal dysfunction underwent preoperative NT-proBNP measurement.
- Cardiac complications within 14 days post-surgery were identified via chart review.
- Multivariate logistic regression and ROC curve analysis were employed to assess NT-proBNP's predictive value.
Main Results:
- Patients experiencing cardiac complications had significantly higher median preoperative NT-proBNP levels (1090 pg/mL) compared to those without (283 pg/mL).
- An NT-proBNP cutoff of 600 pg/mL demonstrated high sensitivity (79%) and specificity (81%) for predicting complications (AUC 0.87).
- Elevated NT-proBNP (>600 pg/mL) was independently associated with a 13-fold increased risk of postoperative cardiac complications.
Conclusions:
- Preoperative NT-proBNP levels exceeding 600 pg/mL are independently linked to increased cardiac complication risk in hip fracture patients without renal impairment.
- NT-proBNP measurement offers valuable clinical information for early prediction of cardiac complications in this population.
- Further research could integrate NT-proBNP into a comprehensive index for predicting postoperative cardiac events.
Background:
Elderly patients with hip fracture are at risk for cardiac complications. N-terminal pro-brain type natriuretic peptide (NT-proBNP) has been shown to predict cardiac complications in surgical patients; however, to our knowledge, only two studies have evaluated the utility of this test in patients with hip fracture. We believe it is important to assess a more accurate cutoff value of NT-proBNP with exclusion of patients with renal failure.
Questions/Purposes:
To assess the association between preoperative NT-proBNP and cardiac complications after hip fracture surgery.
Methods:
We performed 450 surgical procedures in patients with hip fractures between January 2011 and December 2014. Exclusion criteria were renal dysfunction and inadequate laboratory tests. The final study population consisted of 328 patients (mean age, 83 years; 80% women). Preoperatively, measurement of NT-proBNP level was performed. The primary endpoint was the occurrence of cardiac complications within 14 days after surgery based on a chart review. The predictive value of NT-proBNP was assessed using multivariate logistic regression analysis, controlling for relevant confounding variables such as age, gender, body weight, and renal function; we also performed receiver operating characteristic (ROC) curve analysis. Postoperative cardiac complications were encountered in 7% of patients (24 of 328).
Results:
The median preoperative NT-proBNP level was higher in patients with complications than in those without (1090 [interquartile range, 614-3191 pg/mL] vs 283 pg/mL [interquartile range, 137-507 pg/mL], p < 0.001). The cutoff level of NT-proBNP determined by ROC curve analysis was 600 pg/mL, with a sensitivity, specificity, positive predictive value, and negative predictive value of 79%, 81%, 25%, and 98%, respectively, and the area under the ROC curve was 0.87 (95% CI, 0.80-0.94; p < 0.001). After controlling for potentially relevant confounding variables, we found a preoperative NT-proBNP greater than 600 pg/mL was associated with an increased risk of cardiac complications (odds ratio, 13; 95% CI, 4-38; p < 0.001) compared with those with NT-proBNP less than 600 pg/mL.
Conclusions:
Preoperative NT-proBNP greater than 600 pg/mL is independently associated with postoperative cardiac complications in patients with hip fracture without renal dysfunction. NT-proBNP measurement provides additional information and is clinically useful for predicting cardiac complications during the early phase after hip fracture surgery. Future studies might develop a simple index for prediction of postoperative cardiac complication including cutoff values of NT-proBNP.
Level Of Evidence:
Level III, diagnostic study.
Related Concept Videos
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:29Heart Failure II: Pathophysiology
01:22Aneurysm IV: Nursing Management
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management