Bihar: Preoperative serum B-type natriuretic peptides (BNP) is an already known independent predictor of perioperative cardiovascular complications. An observational study published in the BMJ journal Open Heart has shown the role of serum BNP as a predictive marker for postoperative complications in non-cardiac surgery.
Although the study failed to provide specific cutoff values, it found that higher BNP levels, both preoperatively and postoperatively, are linked with an increased risk of complications in patients with hypertension and diabetes undergoing non-cardiac surgery. Serum BNP can potentially emerge as a cost-effective test for risk stratification for postprocedural complications in those undergoing non-cardiac surgery.
Its prognostic advantages include deferral of surgery, modification of surgical procedures, and the ability to tailor therapy postoperatively.
B-type natriuretic peptides are released from myocardial tissues in response to several physiological stimuli, including inflammation, myocardial stretch, myocardial ischaemia and other neuroendocrine stimuli. About 10 million adults annually experience a significant myocardial injury following non-cardiac surgery. To reduce this risk, there is a need for strategies that provide suitable preoperative medical and surgical measures with postoperative management and surveillance.
Studies have shown that increased preoperative serum BNP concentrations are powerful independent predictors of perioperative cardiovascular (CV) complications like heart failure, myocardial infarction (MI), and mortality. In patients undergoing non-cardiac surgery, these are potentially avoidable causes of mortality and morbidity.
Against the above background, Abhishek Singh from AIIMS (All India Institute of Medical Sciences) in Patna, Bihar, India, and colleagues aimed to assess whether preoperative and postoperative serum BNP could predict postoperative complications in patients with diabetes and hypertension post non-cardiac surgery.
The study included 260 adults with known diabetes and hypertension planned who were about to undergo elective non-cardiac surgery. Baseline BNP (preoperative BNP) was measured within surgery 24 hours of, and another postoperative BNP level was measured within 24 hours of surgery.
Change in the BNP levels (delta BNP) was determined between the postoperative and the preoperative BNP levels (baseline BNP) to the baseline B-type natriuretic peptide and the development of postoperative complications within 30 days of the procedure.
Key findings include:
The study showed a correlation between delta BNP and baseline BNP (Pearson's correlation coefficient=0.60).
Researchers found an increased serum BNP both in the preoperative and postoperative periods in the patient group that developed complications, respectively (152.02 pg/mL vs 44.90 pg/mL); (313.99 pg/mL vs 83.95 pg/mL).
The researchers wrote, "we can measure BNP preoperatively and postoperatively for every patient with diabetes and hypertension undergoing major surgery to detect any silent pan-cardiac pathology, and also to risk-stratify patients deemed at high risk to develop surgical complications."
"There is a need for further multicenter prospective studies with a larger population to confirm BNP's role in predicting surgical prognosis," they concluded.
Reference:
Singh A, Kumar A, Hai AA, et alSerum B-type natriuretic peptide levels (BNP) can be used as a predictor of complications in patients undergoing non-cardiac surgery: a prospective observational studyOpen Heart 2023;10:e002256. doi: 10.1136/openhrt-2023-002256