Abstract:The background of this article is to retrospectively investigate the role of B-type natriuretic peptide (BNP) levels as an independent prognostic marker for mortality in diabetic patients with foot ulcer.In the period 1 January-30 June 2009, 279 diabetic patients were admitted to our foot center because of foot ulcer: neuroischemic in 182 (65.2%), neuropathic in 97 (34.8%), infected in 233 (83.5%). In all patients BNP (normal value: ≤ 100 pg/mL) was evaluated at admission.Mortality from any cause was establish… Show more
Objective
This systematic review and meta-analysis aimed at summarizing the existing clinical evidence to evaluate the prognostic performance of N-terminal prohormone brain natriuretic peptide (NT-proBNP) in predicting cardiovascular events, cardiovascular-related mortality, and all-cause mortality in patients with type 2 diabetes.
Methods
Searches were performed in Medline, Embase, Scopus, and Web of Science databases before August 1, 2021. The data were recorded as adjusted hazard ratio (HR).
Results
An increase in NT-proBNP increases the risk of cardiovascular events (HR = 1.63), cardiovascular mortality (HR = 1.86) and all-cause mortality (HR = 1.54). Seemingly, the best cutoffs for predicting cardiovascular events (HR = 2.30) and cardiovascular mortality (HR = 3.77) are levels greater than 100 pg/mL. The best cutoff of NT-proBNP in predicting all-cause mortality is levels greater than 225 pg/mL (HR = 4.72).
Conclusion
A moderate level of evidence demonstrated that NT-proBNP serum levels can predict future cardiovascular events, cardiovascular mortality, and all-cause mortality. Thus, it can be used as risk stratification for type 2 diabetes.
A patient with limb-threatening diabetic foot syndrome in whom relevant peripheral arterial occlusive disease is proven should receive arterial revascularization as soon as possible to avoid major amputation. However, 3 conditions may make it impossible to effectively restore limb perfusion: the patient will not profit from arterial revascularization owing to excessive tissue loss or sepsis ("too late"), the patient cannot be revascularized due to severe comorbidities ("too sick"), and arterial reconstruction is impossible because of technical and anatomical shortcomings in a patient who is otherwise fit for operation ("nonreconstructible limb perfusion"). This review outlines the therapeutic options specifically in the third group of patients in whom no technical option for surgical or endovascular revascularization exists.
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