Influence of Renal Function on the Usefulness of N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Cardiac Risk Marker in Patients Undergoing Noncardiac Vascular Surgery

A meta‐analysis of the utility of pre‐operative brain natriuretic peptide in predicting early and intermediate‐term mortality and major adverse cardiac events in vascular surgical patients

“…Of the three studies that reported on NT-pro-BNP, only one study excluded patients with a serum creatinine exceeding 123 lmol.l )1 [15]. Thus, it is likely that inclusion of patients with renal dysfunction in the other two studies [6,12] may have decreased the specificity of the test [17]. Although exclusion of patients with renal dysfunction in the study by Mahla et al [15] may have decreased the adverse cardiac event rate secondary to a decrease in cardiac clinical risk factors [16], this would not have adversely affected the sensitivity or specificity of the test [1] in their study.…”

“…Whether BNP or NT-pro-BNP is preferable for vascular surgical patients remains unclear. While NT-pro-BNP may be limited by renal dysfunction [17], there is some evidence to suggest that NT-pro-BNP may be a slightly better predictor of outcomes in medical patients with congestive cardiac failure [22] and ischaemic heart disease [23]. It is possible that the longer half-life of NT-pro-BNP may result in it being less affected by peri-operative 2008, 63, pages 1226-1233 .…”

“…The utility of NT-pro-BNP as a predictive marker is highly dependant on the severity of the renal dysfunction, with the best performance in patients with a glomerular filtration rate (GFR) ‡ 90 ml.min )1 .1.73 m )2 [17]. With a GFR < 30 ml.min )1 .1.73 m )2 the prognostic ability of NT-pro-BNP is questionable in vascular surgical patients [17]. Of the three studies that reported on NT-pro-BNP, only one study excluded patients with a serum creatinine exceeding 123 lmol.l )1 [15].…”

“…Thirdly, although renal dysfunction (defined as a serum creatinine > 177 lmol.l ) is an important predictor of major adverse cardiac events in noncardiac surgery [16], decreasing renal function is associated with a lower specificity of NT-pro-BNP for adverse cardiac events [17,18]. The utility of NT-pro-BNP as a predictive marker is highly dependant on the severity of the renal dysfunction, with the best performance in patients with a glomerular filtration rate (GFR) ‡ 90 ml.min )1 .1.73 m )2 [17]. With a GFR < 30 ml.min )1 .1.73 m )2 the prognostic ability of NT-pro-BNP is questionable in vascular surgical patients [17].…”

“…For the intermediateterm outcomes, the optimal discriminatory threshold was determined at a time period longer than 180 days for all three studies analysed [7,11,15]. Thirdly, although renal dysfunction (defined as a serum creatinine > 177 lmol.l ) is an important predictor of major adverse cardiac events in noncardiac surgery [16], decreasing renal function is associated with a lower specificity of NT-pro-BNP for adverse cardiac events [17,18]. The utility of NT-pro-BNP as a predictive marker is highly dependant on the severity of the renal dysfunction, with the best performance in patients with a glomerular filtration rate (GFR) ‡ 90 ml.min )1 .1.73 m )2 [17].…”