Preoperative B-type natriuretic peptide, and not the inflammation status, predicts an adverse outcome for patients undergoing heart surgery☆

Ganem, Fernando; Serrano, Carlos; Fernandes, Juliano Lara; Blotta, Maria Heloı́sa Souza Lima; Souza, Juliana Ascenção de; Nicolau, José Carlos; Ramires, José Antônio Franchini; Hueb, Whady

doi:10.1510/icvts.2010.255257

Cited by 12 publications

(10 citation statements)

References 24 publications

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“…It has been suggested that BNP acts as an important prognostic indicator in the CHF patients, however, NT-proBNP is considered to be a stronger risk bio-indicator for cardiovascular events (Doust et al, 2005). Both BNP and NT-proBNP seem to provide an ideal tool to be utilized as blood tests to diagnose cardiac disorders in patients with high risk of heart failure, diabetes, chronic kidney disease, and coronary artery disease (Khan et al, 2006; Freestone et al, 2008; Czucz et al, 2011; Ganem et al, 2011). The BNP level is increased to almost 200 pg/ml and NT-proBNP levels reaches to approximately 1200 pg/ml in patients with reduced creatinin clearance (McCullough et al, 2003; Anwaruddin et al, 2006).…”

Section: Natriuretic Peptides Synthesis and Secretionmentioning

confidence: 99%

Guanylyl cyclase/natriuretic peptide receptor-A signaling antagonizes phosphoinositide hydrolysis, Ca2+ release, and activation of protein kinase C

Pandey

2014

Front. Mol. Neurosci.

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Thus far, three related natriuretic peptides (NPs) and three distinct sub-types of cognate NP receptors have been identified and characterized based on the specific ligand binding affinities, guanylyl cyclase activity, and generation of intracellular cGMP. Atrial and brain natriuretic peptides (ANP and BNP) specifically bind and activate guanylyl cyclase/natriuretic peptide receptor-A (GC-A/NPRA), and C-type natriuretic peptide (CNP) shows specificity to activate guanylyl cyclase/natriuretic peptide receptor-B (GC-B/NPRB). All three NPs bind to natriuretic peptide receptor-C (NPRC), which is also known as clearance or silent receptor. The NPRA is considered the principal biologically active receptor of NP family; however, the molecular signaling mechanisms of NP receptors are not well understood. The activation of NPRA and NPRB produces the intracellular second messenger cGMP, which serves as the major signaling molecule of all three NPs. The activation of NPRB in response to CNP also produces the intracellular cGMP; however, at lower magnitude than that of NPRA, which is activated by ANP and BNP. In addition to enhanced accumulation of intracellular cGMP in response to all three NPs, the levels of cAMP, Ca2+ and inositol triphosphate (IP3) have also been reported to be altered in different cells and tissue types. Interestingly, ANP has been found to lower the concentrations of cAMP, Ca2+, and IP3; however, NPRC has been proposed to increase the levels of these metabolic signaling molecules. The mechanistic studies of decreased and/or increased levels of cAMP, Ca2+, and IP3 in response to NPs and their receptors have not yet been clearly established. This review focuses on the signaling mechanisms of ANP/NPRA and their biological effects involving an increased level of intracellular accumulation of cGMP and a decreased level of cAMP, Ca2+, and IP3 in different cells and tissue systems.

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Section: Natriuretic Peptides Synthesis and Secretionmentioning

confidence: 99%

Guanylyl cyclase/natriuretic peptide receptor-A signaling antagonizes phosphoinositide hydrolysis, Ca2+ release, and activation of protein kinase C

Pandey

2014

Front. Mol. Neurosci.

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“…Interindividual variations in the initial inflammatory response designated as postoperative complication vectors (32)(33)(34)(35)(36), could thus be a risk factor of postoperative infection. To date, no study evidenced clinical or biological factors that could strongly predict postoperative infectious complications (7)(8)(9)37,38). Other studies investigated the relationship between inflammation activation and the occurrence of secondary bacterial infections.…”

Section: Discussionmentioning

confidence: 99%

“…Events were specifically gated on granulocytes. [Color figure can be viewed at wileyonlinelibrary.com] serious organ failures in the postoperative period, as reflected by a higher SOFA score on D0 (median SOFA: 6 [6][7] vs. 5 [4][5][6], P = 0.037) and on D1 (median SOFA: 2 [1][2][3][4][5] vs. 6 [4][5][6][7][8], P = 0.029). No other preoperative or intraoperative clinical and biological parameters were associated with early postoperative infectious complications ( Supplementary Table S4).…”

Section: Link Between Postoperative Leukocyte Subset and Infectious Cmentioning

confidence: 99%

Immature Granulocytes: A Risk Factor of Infection after Cardiac Surgery

Daix

Guérin

Tavernier

et al. 2018

Cytometry Part B Clinical

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Background Similarly, to sepsis, cardiac surgery with cardiopulmonary bypass (CPB) induces major changes in leukocyte subsets. Immature granulocytes (IGs) increase both in sepsis and after open‐heart surgery. Secondary infections are a major complication of cardiac surgery with CPB. We hypothesized that the assessment of leukocyte subsets with multicolor flow cytometry (FCM) could help the front‐line clinician to better identify patients at high risk of infectious complications in this clinical setting. Methods In this single‐center observational pilot study, we identified 26 leukocyte subsets using three combinations of antibodies (from 5 to 10 colors per combinations): one devoted to granulocytes, one to lymphocyte subpopulations and one for rare cells (plasma cells and dendritic cells). Blood samples were obtained preoperatively and immediately after open‐heart surgery under CPB in 59 patients without immuno‐depression, chronic or neoplastic inflammatory disease, and immunosuppressive treatment. Secondary infections during hospital stay were recorded. Results Patients exhibited postoperative NK and T‐cell lymphopenia, increased levels of IGs and monocytes with low levels of surface HLA DR. Twelve patients developed secondary infectious complications. Only immediate postoperative IG levels were significantly higher in these patient (6.6 [6; 7.39] G/L vs. 3.8 [2.67; 5.72] G/L, P = 0.01). Patients with immediate postoperative increase of IGs developed more frequently infectious complication (10/22 [46%] vs. 2/37 [5%]: P < 0.001). Conclusions This study suggests that postoperative increase of IGs is related to postoperative organ failure and promises to help in early identification of patients at risk of infectious complications after open‐heart surgery under CPB. © 2018 International Clinical Cytometry Society

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“…Für Patienten, die sich kardialen Operationen unterziehen müssen, belegt eine aktuelle Arbeit in Analogie zu den nichtkardialen Operationen, dass die B-natriuretischen Peptide besser als die klassischen Entzündungsparameter das Risiko der Patienten abschätzen können [19]. Auch hier fehlen prospektive Studien, die den Einfluss der präoperativen Bestimmung auf die perioperative Mortalität und Letalität aufzeigen.…”

Section: Introductionunclassified

Kardiale Biomarker in der perioperativen Medizin

et al. 2011

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Perioperative detection of cardiac biomarkers may help to identify patients at risk. Whether detection of these markers will be recommended in the preoperative setting for patients with cardiac diseases in the future has to be discussed as large prospective trials on this topic are missing. For preoperative evaluation of cardiac insufficiency quantification of brain natriuretic peptide (BNP) and amino-terminal pro-brain natriuretic peptide (NT-proBNP) are useful markers. Troponin is the marker of choice for detection of myocardial ischemia/infarction in the postoperative setting. In unstable patients coronary angiography and/or percutaneous coronary intervention (PCI) are indicated. However, in stable patients the decision for coronary angiography and/or PCI has to be made in each patient individually after interdisciplinary discussion between anesthesiologists, cardiologists and surgeons.

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Preoperative B-type natriuretic peptide, and not the inflammation status, predicts an adverse outcome for patients undergoing heart surgery☆

Abstract: BNP correlates with clinical endpoints more than inflammatory markers and can be used as a predictor of early outcome after heart surgery.

Cited by 12 publications

References 24 publications

Guanylyl cyclase/natriuretic peptide receptor-A signaling antagonizes phosphoinositide hydrolysis, Ca2+ release, and activation of protein kinase C

Guanylyl cyclase/natriuretic peptide receptor-A signaling antagonizes phosphoinositide hydrolysis, Ca2+ release, and activation of protein kinase C

Immature Granulocytes: A Risk Factor of Infection after Cardiac Surgery

Kardiale Biomarker in der perioperativen Medizin

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