Korean Circ J.  2012 Aug;42(8):521-527. 10.4070/kcj.2012.42.8.521.

Postoperative B-Type Natriuretic Peptide Levels Associated With Prolonged Hospitalization in Hypertensive Patients After Non-Cardiac Surgery

• Park JH
• Shin GJ
• Ryu JI
• Pyun WB

• KMID: 2225001
• DOI: http://doi.org/10.4070/kcj.2012.42.8.521

Abstract

BACKGROUND AND OBJECTIVES
B-type natriuretic peptide (BNP) is an important marker for the diagnosis of heart failure and is useful towards predicting morbidity and mortality after non-cardiac surgery. Nevertheless, information on the relationship between postoperative BNP levels and perioperative prognosis after non-cardiac surgery is scarce. The purpose of the study was to assess whether postoperative BNP levels could be used as a predictor of prolonged hospitalization in elderly hypertensive patients after non-cardiac surgery.
SUBJECTS AND METHODS
Ninety-seven (97) patients, aged 55 years or older (mean age: 73.12+/-10.05 years, M : F=24 : 73) were enrolled in a prospective study from May 2005 through August 2010. All patients underwent total knee or hip replacement. Postoperative BNP and other diagnostic data were recorded within 24 hours of surgery. Patients that required a prolonged hospital stay due to operative causes, such as wound infection and re-operation, were excluded.
RESULTS
The length of hospital stay was significantly correlated with postoperative BNP levels (p=0.031). Receiver operating characteristic curves demonstrated postoperative BNP levels as predictors of hospital stay > or =30 days with areas under the curve of 0.774 (95% confidence interval: 0.679-0.87, p<0.0001). A BNP cut-off value above 217.5 pg/mL had a sensitivity of 80.6% and a specificity of 66.7% for predicting postoperative hospital stays of 30 days or more.
CONCLUSION
Postoperative BNP levels may predict the length of hospital stays after non-cardiac surgery in hypertensive patients. Elevated BNP levels were associated with prolonged hospitalization after elective orthopedic surgery.

Keyword

Natriuretic peptin, brain; Hospitalization; Postoperative period; Hypertension

MeSH Terms

Aged
Heart Failure
Hip
Hospitalization
Humans
Hypertension
Knee
Length of Stay
Natriuretic Peptide, Brain
Orthopedics
Postoperative Period
Prognosis
Prospective Studies
ROC Curve
Sensitivity and Specificity
Wound Infection
Natriuretic Peptide, Brain

Figure

• 

  Fig. 1 A comparison of postoperative BNP levels in patients with over 30 days hospitalization and under 30 days hospitalization. Central lines represent medians, box represent 25th and 75th precentiles. Postoperative BNP level was higher in Group I than Group II (Group I vs. Group II: 6483.93±1147.79 pg/mL vs. 1708.03±6118.22 pg/mL, p=0.031). BNP: B-type natriuretic peptide.

• 

  Fig. 2 Receiver operating characteristics curve was constructed to determine the postoperative B type natriuretic peptide cut-off value for predictive power of predicting the prolonged hospital stay. A cut-off of 217.5 pg/mL yielded the maximal combined sensitivity of 80.6% and specificity of 66.7%. Area under the curve=0.774 (95% confidence interval=0.679-0.870, p<0.0001). AUC: area under the curve, BNP: B-type natriuretic peptide.

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