B-Type Natriuretic Peptide and Risk of Acute Kidney Injury in Patients Hospitalized With Acute Coronary Syndromes*

Moltrasio, Marco; Cabiati, Angelo; Milazzo, Valentina; Rubino, Mara; Metrio, Monica De; Discacciati, Andrea; Rumi, Paola; Marana, Ivana; Marenzi, Giancarlo

doi:10.1097/ccm.0000000000000025

Cited by 20 publications

(11 citation statements)

References 21 publications

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“…Our study extends the finding of that study and suggests that preoperative NT-proBNP is independently associated with AKI in patients undergoing mixed types of non-cardiac surgery. This result is in accordance with observations in previous studies showing that NT-proBNP/BNP concentrations were associated with risk of AKI after cardiac surgery [19] and in other acute care settings [14][15][16][17][18].…”

Section: Discussionsupporting

confidence: 93%

“…Because the incidence of AKI after non-cardiac surgery is relatively low, and because conventional risk factors have good prediction performance for postoperative AKI, even biomarkers with an independent association with AKI (such as BNP) may not improve the discrimination ability of existing clinical models [17]. Despite these challenges, in our study, NT-proBNP offered modest but statistically significant improvements in the AUC, the continuous and categorical NRI, and the IDI.…”

Section: Discussionmentioning

confidence: 70%

“…These models are all based solely on conventional clinical and laboratory-based variables. Recent studies have associated cardiac biomarkers B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) with risk of AKI in several medical settings [14][15][16][17][18] and in cardiac surgery [19]. Moreover, natriuretic peptides are established and guideline-recommended biomarkers for perioperative cardiovascular risk assessment in patients with elevated baseline risks undergoing non-cardiac surgery [20][21][22][23][24][25].…”

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confidence: 99%

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Preoperative N-terminal pro-B-type natriuretic peptide for prediction of acute kidney injury after non-cardiac surgery: A retrospective cohort study

Zhao

Zhuang

Lei

et al. 2020

Preprint

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Background Acute kidney injury (AKI) is associated with poor outcomes after non-cardiac surgery. Whether preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts AKI after non-cardiac surgery is unclear. Methods We conducted a retrospective study on patients whose NT-proBNP concentrations were measured before non-cardiac surgery at a tertiary academic hospital between 2008 and 2018. Multivariable logistic regression was used to investigate the predictive role of preoperative NT-proBNP on postoperative AKI defined by the Kidney Disease: Improving Global Outcomes creatinine criteria. Results Some 6.1% (444 of 7248) of patients developed AKI within 1 week after surgery. Preoperative NT-proBNP was an independent predictor of AKI after adjustment for clinical variables (odd ratio comparing top to bottom quintiles 2.29, 95% confidence interval [CI] 1.47-3.65, p<0.001 for trend; odd ratio per 1-unit increment in natural log transformed NT-proBNP 1.27, 95% CI 1.16-1.39). Compared with clinical variables alone, the addition of NT-proBNP modestly improved the discrimination (change in area under the curve from 0.764 to 0.773, p=0.005) and reclassification (continuous net reclassification improvement 0.210, 95% CI 0.111-0.308; integrated discrimination improvement 0.0044, 95% CI 0.0016-0.0072) of AKI and non-AKI cases. Conclusions Preoperative NT-proBNP concentrations provided predictive information for AKI in a cohort of patients undergoing non-cardiac surgery, independent of and incremental to conventional risk factors. Prospective studies are required to confirm this finding and examine its clinical impact.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 70%

mentioning

confidence: 99%

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Preoperative N-terminal pro-B-type natriuretic peptide for prediction of acute kidney injury after non-cardiac surgery: A retrospective cohort study

Zhao

Zhuang

Lei

et al. 2020

Preprint

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“…A substudy of HORIZONS-AMI, [14] including a total of 979 patients, found an independent predictive value of brain natriuretic peptide (BNP) for CI-AKI after PCI. Similarly, Moltrasio et al [26] and Akgul et al [27] also identified BNP level at admission as being associated with CI-AKI and its severity. Although BNP level correlates with NT-proBNP level, NT-proBNP levels are more stable and sensitive than BNP levels because of a longer half-life.…”

Section: Discussionmentioning

confidence: 90%

Association of N-terminal pro-brain natriuretic peptide with contrast-induced acute kidney injury and long-term mortality in patients with heart failure and mid-range ejection fraction

Wang

Chen

et al. 2017

Medicine

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The potential value of N-terminal pro-brain natriuretic peptide (NT-proBNP) for contrast-induced acute kidney injury (CI-AKI) in patients with heart failure and mid-range ejection fraction (HFmrEF) is unclear. We investigated whether NT-proBNP is associated with CI-AKI and long-term mortality following elective cardiac catheterization in patients with HFmrEF.A total of 174 consecutive patients with HFmrEF undergoing elective coronary angiography or intervention were enrolled. The primary endpoint was the development of CI-AKI, defined as an absolute increase of ≥0.3 mg/dL or ≥ 50% from baseline serum creatinine with 48 hours after contrast medium exposure. Receiver-operating characteristic curve analysis was conducted, and Youden index was used to determine the best cutoff NT-proBNP value. Multivariable logistic regression and Cox proportional hazards regression analyses were performed to identify the independent risk factors for CI-AKI and long-term mortality, respectively.The incidence of CI-AKI was 12.1%. Patients with CI-AKI had higher NT-proBNP values than those without (4373[1561.9–7470.5] vs 1303[625.2–2482.3], P = 0.003). Receiver-operating characteristic curve revealed that NT-proBNP was not significantly different from the Mehran risk score in predicting CI-AKI (area under the curve [AUC] = 0.723 vs 0.767, P = 0.516). The best cutoff NT-proBNP value for CI-AKI was 3299 pg/mL, with 70.6% sensitivity and 83.1% specificity. Multivariable analysis demonstrated that NT-proBNP ≥3299 pg/mL is significantly related to CI-AKI (odds ratio = 12.79; 95% confidence interval, 3.18–51.49; P < 0.001). Cox regression analysis showed that NT-proBNP ≥3299 pg/mL is associated with long-term mortality (adjusted hazard ratio = 11.91; 95%CI, 2.16–65.70; P = 0.004) during follow-up.In patients with HFmrEF, NT-proBNP ≥3299 pg/mL is associated with CI-AKI and long-term mortality following elective coronary angiography or intervention.

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“…They found that BNP was associated with AKI as well as its severity in patients with ACS. 28 However, these studies reported BNP instead of NT-pro-BNP levels. NT-pro-BNP levels may have analytical advantages over BNP, given the enhanced stability due to a longer half-life, which allows for increased accumulation and potentially greater sensitivity for detecting more subtle structural and functional changes.…”

Section: Discussionmentioning

confidence: 99%

Association of N-Terminal Pro-B-Type Natriuretic Peptide With Contrast-Induced Nephropathy and Long-Term Outcomes in Patients With Chronic Kidney Disease and Relative Preserved Left Ventricular Function

Liu

Zhou³

et al. 2015

Medicine

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The aim of the present article was to evaluate the association of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) with contrast-induced nephropathy (CIN) and long-term outcomes in patients with chronic kidney disease (CKD) and relative preserved left ventricular function (LVF) undergoing percutaneous coronary intervention (PCI).We prospectively enrolled 1203 consecutive patients with CKD and preserved LVF undergoing elective PCI. The primary end point was the development of CIN, defined as an absolute increase in serum creatinine (SCr) ≥0.5 mg/dL, from baseline within 48 to 72 hours after contrast medium exposure.CIN incidence varied from 2.2% to 5.2%. Univariate logistic analysis showed that lg-NT-pro-BNP was significantly associated with CIN (odds ratio [OR] = 3.93, 95% confidence interval [CI], 2.22–6.97, P < 0.001). Furthermore, lg-NT-pro-BNP remained a significant predictor of CIN (OR = 3.30, 95% CI, 1.57–6.93, P = 0.002), even after adjusting for potential confounding risk factors. These results were confirmed by using other CIN criteria, which were defined as elevations of the SCr by 25% or 0.5 and 0.3 mg/dL from the baseline. The best cutoff value of lg-NT-pro-BNP for detecting CIN was 2.73 pg/mL (537 pg/mL) with 73.1% sensitivity and 70.0% specificity according to the receiver operating characteristic (ROC) analysis (C statistic = 0.754, 95% CI, 0.67–0.84, P < 0.001). In addition, NT-pro-BNP ≥537 pg/mL (2.73 pg/mL, lg-NT-pro-BNP) was associated with an increased risk of all-cause mortality and composite end points during 2.5 years of follow-up.NT-pro-BNP ≥537 pg/mL is independently associated with an increased risk of CIN with different definitions and poor clinical outcomes in patients with CKD and relative preserved LVF undergoing PCI.

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B-Type Natriuretic Peptide and Risk of Acute Kidney Injury in Patients Hospitalized With Acute Coronary Syndromes*

Abstract: In patients hospitalized with acute coronary syndromes, B-type natriuretic peptide levels measured at admission are associated with acute kidney injury as well as its severity.

Cited by 20 publications

References 21 publications

Preoperative N-terminal pro-B-type natriuretic peptide for prediction of acute kidney injury after non-cardiac surgery: A retrospective cohort study

Preoperative N-terminal pro-B-type natriuretic peptide for prediction of acute kidney injury after non-cardiac surgery: A retrospective cohort study

Association of N-terminal pro-brain natriuretic peptide with contrast-induced acute kidney injury and long-term mortality in patients with heart failure and mid-range ejection fraction

Association of N-Terminal Pro-B-Type Natriuretic Peptide With Contrast-Induced Nephropathy and Long-Term Outcomes in Patients With Chronic Kidney Disease and Relative Preserved Left Ventricular Function

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