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KMID : 0828520120160040184
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Journal of the Korean Geriatrics Society
2012 Volume.16 No. 4 p.184 ~ p.191
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Preoperative B-type Natriuretic Peptide as a Predictor of Postoperative Cardiac Events Following Orthopedic Elderly Patients
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Lee Ga-Ram
Jeon Young-Do
Jung Ja-Young
Min Ji-Won
Park Seon-Young
Lee Seung-Hun
Sir Jung-Ju
Choi Seung-Min
Joo Shin-Bae
Lee Joong-Myung
Lee Hong-Soon
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Abstract
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Background: The aim of this study was to evaluate the value of preoperative plasma B-type natriuretic peptide(BNP) level in predicting postoperative in-hospital major adverse cardiac events(MACE, defined as atrial fibrillation, congestive heart failure, nonfatal myocardial infarction and cardiac death) in elderly patients undergoing orthopedic surgery.
Methods: Between March 2010 and September 2011, data from 156 patients(aged 65 years or older) who underwent scheduled or emergent orthopedic surgery, were investigated. Screening for postoperative in-hospital MACE was performed using clinical criteria.
Results: MACE occurred in 12 patients(7.7%). The BNP level was significantly higher in patients with MACE than in those without(median,152.0; interquartile range[36.3 to 352.8]pg/mL vs. median, 36.8; interquartile range[15.5 to 98.1]pg/mL, p=0.005). The BNP level was positively correlated with the revised cardiac risk index score(r=0.300, p=0.001). In a receiver operating characteristic(ROC) analysis for MACE, the ROC for BNP was 0.746(95% confidence interval, 0.602 to 0.891). At the optimal cut-off point(BNP=110pg/mL), the sensitivity, specificity and positive and negative predictive values were 66.7, 81.2, 22.0% and 96.6%, respectively. On multivariate analysis, preoperative BNP was an independent predictor for MACE(odds ratio, 5.091; p=0.018) after adjusting for baseline confounding factors such as diabetes mellitus and history of cerebrovascular accident.
Conclusion: The preoperative BNP level may be a useful tool in stratifying the risk for MACE in elderly patients undergoing orthopedic surgery.
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KEYWORD
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B-type natriuretic peptide, Orthopedic surgery, Preoperative, Adverse cardiac events
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