AUTHOR=Zhao Yi , Hao Xuechao , Zhu Yihao , Chen Mingkai , Ou Mengchan , Zhu Tao 

TITLE=A Combination of N-Terminal proB-Type Natriuretic Peptide and Myoglobin Can Predict Severe Complications After Major Non-Cardiac Surgery in Elderly Patients: A Prospective Observational Cohort Study

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.679260

DOI=10.3389/fmed.2021.679260

ISSN=2296-858X

ABSTRACT=Abstract
Background: Previous studies demonstrated that serum N-terminal proB-type natriuretic peptide (NT-proBNP) was a predictor of adverse cardiovascular outcomes after surgery. We performed a prospective study to evaluate if NT-proBNP could be a sensitive marker of overall postoperative outcomes in older patients undergoing major elective non-cardiac surgery when combined with myoglobin (MYO).
Methods: 203 adults aged at least 65 years were recruited. The American Society of Anesthesiologists (ASA) physical status of patients were I to IV. All patients underwent venous blood sampling and had measurements of NT-proBNP and MYO concentrations before (NT-proBNP baseline / MYO baseline) and 2 h after (NT-proBNP – 2 h / MYO – 2 h) the surgery. The primary outcome was moderate to severe complications based on Clavien-Dindo Classification (CDC) scheme and secondary outcome was major complications within 30 days after surgery. This study registered at China Clinical Trial Registry (ChiCTR1900026223, http://www.chictr.org.cn/).
Results: Overall, moderate to severe complications occurred in 15 patients (7.4%) and major complications occurred in 18 patients (8.9%). Both preoperative and postoperative NT-proBNP values were independent predictors of moderate to severe complications (AUC, 0.820; 95% CI: 0.728, 0.912, P<0.001; AUC, 0.785; 95% CI: 0.685, 0.885, P<0.001). When NT-proBNP baseline and MYO – 2 h were combined, the predictive power was improved (AUC 0.841, 95% CI: 0.758, 0.923, P<0.001).
Conclusions: A combination of perioperative NT-proBNP and postoperative MYO concentration is a good predictor of postoperative complications in elderly patients underwent major non¬cardiac surgery. For the fast and dynamic tests provided by POCT facilitates, NT-proBNP and MYO concentration measurement can provide instructions for therapies before or soon after the surgery, and may help us to reduce postoperative complications in elderly patients.