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. 2021 Feb;13(2):955-967.
doi: 10.21037/jtd-20-2375.

B-type natriuretic peptide as a surrogate marker for survival in patients undergoing cardiac surgery

Ju Yong Lim  1 , Sung Ho Jung  2 , Suk Jung Choo  2 , Cheol Hyun Chung  2 , Jae Won Lee  2 , Joon Bum Kim  2
Affiliations

B-type natriuretic peptide as a surrogate marker for survival in patients undergoing cardiac surgery

Ju Yong Lim et al. J Thorac Dis. 2021 Feb.

Abstract

Background: B-type natriuretic peptide (BNP) is a biomarker predicting morbidity and mortality in patients with congestive heart failure. However, the usefulness of pre- or postoperative BNP levels in patients undergoing cardiac surgery remains uncertain. We sought to determine the association of pre- or postoperative BNP levels on mortality in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB).

Methods: This study retrospectively evaluated 1,642 patients undergoing cardiac surgery under CPB over 2 years. The primary outcomes were 30-day and overall mortality after cardiac surgery.

Results: The 30-day mortality rate was 3.0% (n=49), and the overall mortality occurred in 118 patients during the mean follow-up period of 24.9±8.9 months. In multivariable analyses, preoperative BNP level was not significantly associated with 30-day [odds ratio (OR), 1.03; 95% confidence interval (CI), 0.99-1.06; P=0.06] or overall [hazard ratio (HR), 1.01; 95% CI, 0.98-1.03; P=0.50] mortalities. However, the postoperative BNP level was significantly associated with 30-day (OR, 1.05; 95% CI, 1.02-1.09; P=0.001) and overall (HR, 1.03; 95% CI, 1.01-1.04; P=0.01) mortalities. As a sensitivity analysis, postoperative BNP levels were divided into quartiles. The top quartile (≥484 pg/mL) was identified as a strong predictor of overall mortality (HR, 2.18; 95% CI, 1.14-4.19; P=0.02).

Conclusions: Preoperative BNP level was not associated with mortality after cardiac surgery. However, postoperative BNP level was associated with mortality after cardiac surgery, especially in patients with high levels (≥484 pg/mL). Further studies in larger cohorts are necessary to validate these results.

Keywords: Natriuretic peptide; brain; cardiac surgical procedures; cardiopulmonary bypass (CPB); heart failure.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-2375). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The study population. CABG, coronary artery bypass grafting; CPB, cardiopulmonary bypass; BNP, B-type natriuretic peptide.
Figure 2
Figure 2
Association between postoperative BNP level and mortalities. (A) Probability of 30-day mortality according to the (log) postoperative BNP level; (B) probability of death within 2-year according to the (log) postoperative BNP level estimated by logistic regression models. BNP, B-type natriuretic peptide.
Figure 3
Figure 3
The probability of overall survival of the postoperative BNP level according to quartiles during the follow-up period. Increased risk of mortality in the top quartile (BNP ≥484 pg/mL) (orange line) compared to the bottom three quartiles (green, red, and blue line) (P<0.001). BNP, B-type natriuretic peptide.
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