N-terminal pro-B-type natriuretic peptide (NT–pro-BNP) is related to stress-induced
myocardial ischemia and/or volume overload, both common in patients with renal dysfunction.
This might compromise the prognostic usefulness of NT–pro-BNP in patients with renal
impairment before vascular surgery. We assessed the prognostic value of NT–pro-BNP
in the entire strata of renal function. In 356 patients (median age 69 years, 77%
men), cardiac history, glomerular filtration rate (GFR, ml/min/1.73 m2), and NT–pro-BNP level (pg/ml) were assessed preoperatively. Troponin T and electrocardiography
were assessed postoperatively on days 1, 3, 7, and 30. The end point was the composite
of cardiovascular death, Q-wave myocardial infarction, and troponin T release. Multivariate
analysis was used to evaluate the interaction between GFR, NT–pro-BNP and their association
with postoperative outcome. Median GFR was 78 ml/min/1.73 m2 and the median concentration of NT–pro-BNP was 197 pg/ml. The end point was reached
in 64 patients (18%); cardiac death occurred in 7 (2.0%), Q-wave myocardial infarction
in 34 (9.6%), and non–Q-wave myocardial infarction in 23 (6.5%). After adjustment
for confounders, NT–pro-BNP levels and GFR remained significantly associated with
the end point (p = 0.005). The prognostic value of NT–pro-BNP was most pronounced
in patients with GFR ≥90 (odds ratio [OR] 1.18, 95% confidence interval [CI] 0.80
to 1.76) compared with patients with GFR 60 to 89 (OR 1.04, 95% CI 1.002 to 1.07),
and with GFR 30 to 59 (OR 1.12, 95% CI 1.03 to 1.21). In patients with GFR <30 ml/min/1.73
m2, NT–pro-BNP levels have no prognostic value (OR 1.00, 95% CI 0.99 to 1.01). In conclusion,
the discriminative value of NT–pro-BNP is most pronounced in patients with GFR ≥90
ml/min/1.73 m2 and has no prognostic value in patients with GFR <30 ml/min/1.73 m2.
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Article Info
Publication History
Accepted:
July 13,
2007
Received in revised form:
July 13,
2007
Received:
May 9,
2007
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
