Plasma N-terminal pro-B-type natriuretic peptide as a predictor of perioperative and long-term outcome after vascular surgery

Schouten, Olaf; Hoeks, Sanne E.; Goei, Dustin; Bax, Jeroen J.; Verhagen, Hence J.M.; Poldermans, Don

doi:10.1016/j.jvs.2008.08.063

Cited by 36 publications

(25 citation statements)

References 21 publications

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“…(22) It has recently been shown that NT-proBNP is associated with adverse cardiovascular events and mortality in patients undergoing vascular surgery. (23) Another intriguing possibility is that higher HMWA in some patients might be indicative of a wasting process. (24) It has been shown that circulating adiponectin levels are higher in patients undergoing weight loss.…”

Section: Discussionmentioning

confidence: 99%

Novel adipokines, high molecular weight adiponectin and resistin, are associated with outcomes following lower extremity revascularization with autogenous vein

Owens

Kim

Hevelone

et al. 2010

Journal of Vascular Surgery

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Objective A significant portion of patients undergoing lower extremity bypass surgery (LEB) for peripheral arterial disease (PAD) will have cardiovascular or graft-related events. It has been previously demonstrated that systemic inflammation is associated with PAD and its clinical outcomes. We hypothesized that serum biomarkers of insulin resistance and inflammation would identify a sub-group at elevated risk for graft failure, limb loss, and mortality. Methods This was a prospective longitudinal study of patients (N=225) undergoing LEB using autogenous vein. Baseline blood samples were obtained prior to surgery in the fasting state. High-sensitivity C-reactive protein (hsCRP) and the adipokines resistin and high-molecular weight adiponectin (HMWA) were measured by ELISA. Median follow-up was 893 days. The major endpoints of primary patency (PP) and amputation free survival (AFS) were examined using multivariable methods. Endpoints were screened against biomarkers and patient characteristics for univariate associations. Promising explanatory variables (P < 0.1) were included in multivariable Cox proportional hazard models. Results The mean age of subjects was 67.6 years; 71.6% were male and 87.1% were Caucasian. One-hundred and thirty-three (59.1%) subjects underwent bypass for critical limb ischemia (CLI) and 73 (32.4%) had tissue loss. Patients with CLI and diabetes demonstrated elevated resistin and hsCRP levels. HMWA levels correlated with CLI and with a measure of insulin resistance (HOMA-IR) but not with clinical diabetes. Baseline biomarkers were higher in those presenting with tissue loss and in patients with post-operative events (mortality, limb loss). After multivariable analysis (including CLI, diabetes, age, estimated glomerular filtration rate (eGFR), adiponectin, resistin, and CRP), resistin (HR 1.75, 95% CI 1.07 to 2.85, P=0.025) and CRP (HR 2.39, 95% CI 1.30 to 4.39, P=0.005) were independently predictive of reduced AFS. However, only resistin maintained its significance when restricted to the diabetic cohort (HR 2.10, 95% CI 1.10 to 3.99, P=0.025). Higher levels of HMWA were found to be associated with primary graft patency (HR 0.73 for graft failure, 95% CI 0.55 to 0.97, P=0.031) in a multivariable model adjusting for diabetes, CRP, African-American race, CLI, high-risk conduits, and redo bypass procedures. Conclusion These findings suggest that serum biomarkers of insulin resistance and inflammation may be predictive of clinical outcomes following LEB. Improving the systemic milieu of insulin resistance and inflammation in these high-risk patients may lead to reduced morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Novel adipokines, high molecular weight adiponectin and resistin, are associated with outcomes following lower extremity revascularization with autogenous vein

Owens

Kim

Hevelone

et al. 2010

Journal of Vascular Surgery

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“…8) Furthermore, some reports have stated that NTproBNP is useful as a prognostic indicator of cardiovascular events such as acute coronary syndrome, postoperative cardiovascular disease, and stable coronary artery disease. 11,12) Fukuda et al reported that a numerical formula based on blood BNP concentrations in chronic heart failure patients at discharge could predict prognosis after discharge with a high probability. 13) In other words, a high NTproBNP level may indicate heart failure requiring treatment and may also identify a poor outcome.…”

Section: Significance Of Ntprobnpmentioning

confidence: 99%

N-terminal Pro-brain Natriuretic Peptide Level as a Prognostic Predictor in Elderly Patients in a Convalescent Rehabilitation Ward

Shiba

Kurata²,

Sasaki

et al. 2017

PRM

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Objective: N-terminal pro-brain natriuretic peptide (NTproBNP) levels were investigated to predict outcomes for elderly patients in a convalescent rehabilitation ward. Methods: The study included 75 patients aged at least 75 years who were admitted to the convalescent rehabilitation ward of Naruto-Yamakami Hospital. Based on NTproBNP levels on admission, the patients were divided into those with NTproBNP levels ≥400 pg/ml (Group A) and those with NTproBNP levels <400 pg/ml (Group B). Patients were also divided into three groups according to their outcomes: Group I, death-related discharge or emergency transfer; Group II, home discharge; and Group III, medical/nursing care continuation. Group A patients were further divided, according to the time course of NTproBNP levels, into Group A-I (levels increased) and A-II (levels unchanged/ decreased). The correlation coefficients between outcomes and each measurement index were determined, and discriminant analysis was performed among the groups. Results: The NTproBNP level on hospitalization was significantly higher in Group I than in Groups II and III. There were significantly more death-related discharges and emergency transfers in Group A than in Group B and in Group A-I than in Group A-II. In discriminant analysis, assuming the outcome to be a dependent variable in Group A-I and Group A-II, the canonical correlation was 0.81 (P<0.05). Conclusion:The study findings suggest that NTproBNP levels are useful for predicting patient outcomes.

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“…12 Studies also demonstrate that elevated preoperative BNP in patients undergoing aortic aneurysm repair, carotid endarterectomy, and peripheral vein bypass correlates with increased risk for postoperative cardiac events including nonfatal myocardial infarction and cardiovascular death. 13,14 However, the predictive value of BNP in PAD patients undergoing EVT remains unknown.…”

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confidence: 99%

C-reactive protein and brain natriuretic peptide as predictors of adverse events after lower extremity endovascular revascularization

Stone

Schlarb

Campbell

et al. 2014

Journal of Vascular Surgery

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Background High-sensitivity C-reactive protein (hsCRP) and brain natriuretic peptide (BNP) have been shown to be independent predictors of adverse cardiovascular outcomes and increased risk of secondary interventions or limb loss in patients with peripheral arterial disease (PAD). To assist clinicians in decision-making about treatment approaches and predicting postprocedure mortality and morbidity, we retrospectively examined patients with preprocedure hsCRP and BNP levels who underwent elective angioplasty or stent placement for lower extremity PAD. Methods The study period was from January 1, 2007, to December 31, 2012, and patients were included who had angioplasty or stenting for PAD. Minimal required follow-up for study inclusion was at least one postoperative ankle-brachial index, contrast angiography, or duplex imaging of the treated limb. Events of interest included major adverse limb events (MALE), defined as target vessel revascularization, amputation, or disease progression by 1 year, and major adverse cardiovascular events (MACE; stroke, myocardial infarction, or death) by 2 years. Elevated/abnormal values for our biomarkers of interest were established by the upper limits of our institution's clinical laboratory reference range (hsCRP, >0.80 mg/dL; BNP, >100 pg/mL). Results A total of 159 limbs in 118 patients were included in analysis (42% men; median age [range], 64 [42-87] years). All limbs were symptomatic (Rutherford classification: 1-6). Iliac artery revascularization without other adjunct lower extremity intervention was performed in 60% of the limbs. High hsCRP levels (>0.80 mg/dL) were present in 32 patients (27%) and high BNP values (>100 pg/mL) in 24 patients (20%). Kaplan-Meier analysis with log-rank comparison demonstrated that elevated hsCRP levels were associated with MALE but only in limbs receiving interventions distal to the iliac arteries (P = .005). High BNP levels did not affect MALE rates (P = .821). Conversely, both elevated BNP levels (hazard ratio, 5.6; 95% confidence interval [CI], 2.0-5.8; P = .001) and hsCRP levels (hazard ratio, 2.9; 95% CI, 1.1-7.6; P = .034) predicted MACE at 2 years in the presence of confounders in Cox proportional hazards multivariate analysis. Patients with high preintervention values of hsCRP and BNP were 10.6 times (95% CI, 2.6-42.9; P = .001) more likely to experience MACE than were patients with normal hsCRP and BNP values. Conclusions After lower extremity endovascular interventions, elevated preprocedural hsCRP levels are associated with MALE (femoral-popliteal interventions), and elevated levels of hsCRP and BNP are associated with late cardiovascular events.

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Plasma N-terminal pro-B-type natriuretic peptide as a predictor of perioperative and long-term outcome after vascular surgery

Abstract: NT-proBNP is an independent prognostic marker for postoperative cardiac events and long-term mortality in patients undergoing different types of vascular surgery and might be used for preoperative cardiac risk stratification.

Cited by 36 publications

References 21 publications

Novel adipokines, high molecular weight adiponectin and resistin, are associated with outcomes following lower extremity revascularization with autogenous vein

Novel adipokines, high molecular weight adiponectin and resistin, are associated with outcomes following lower extremity revascularization with autogenous vein

N-terminal Pro-brain Natriuretic Peptide Level as a Prognostic Predictor in Elderly Patients in a Convalescent Rehabilitation Ward

C-reactive protein and brain natriuretic peptide as predictors of adverse events after lower extremity endovascular revascularization

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