The predictive value of NT-proBNP and hs-TnT for risk of death in cardiac surgical patients

• Published in: Clinical biochemistry Vol. 53; pp. 65 - 71
• Main Authors: Brynildsen, Jon, Petäjä, Liisa, Pettilä, Ville, Nygård, Ståle, Vaara, Suvi T., Linko, Rita, Okkonen, Marjatta, Hagve, Tor-Arne, Soininen, Leena, Suojaranta-Ylinen, Raili, Lyngbakken, Magnus Nakrem, Omland, Torbjørn, Røsjø, Helge
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2018
• Subjects: Biomarkers; Cardiac surgery; NT-proBNP; Risk assessment; Troponin T; NYHA; OR; NRI; ROC; LVEF; FINNAKI; HR; Cardiac surgery; IQR; FINNALI; Troponin T; AUC; CCS; NT-proBNP; CV; Risk assessment; Biomarkers; EuroSCORE; hs-TnT; ICU; SEM; CABG; AMI
• ISSN: 0009-9120; 1873-2933
• DOI: 10.1016/j.clinbiochem.2018.01.012

European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is used for risk stratification before cardiac surgery, but whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT) may add prognostic information to EuroSCORE II is not known.
Preoperative (n=640) and postoperative (n=629) blood samples were available from cardiac surgical patients with 961-day follow-up (FINNAKI Heart study; cohort #1). The accuracy of a parsimonious risk model with NT-proBNP measurements was also tested in 90 patients with respiratory failure after cardiac surgery (FINNALI study; cohort #2).
Sixty-one patients (9.5%) died during follow-up in cohort #1. Preoperative NT-proBNP and hs-TnT concentrations correlated (rho=0.58; p<0.001) and were higher in non-survivors compared to survivors: median 2027 (Q1-3 478-5387) vs. 373 (134–1354) ng/L [NT-proBNP] and 39 (16–191) vs. 13 (8–32) ng/L [hs-TnT]; p<0.001 for both. Preoperative NT-proBNP concentrations were associated with time to death after adjustment for EuroSCORE II (HR [lnNT-proBNP] 1.33 [95% CI 1.08–1.64]), p=0.008 and reclassified patients on top of EuroSCORE II (net reclassification index 0.39 [95% CI 0.14–0.64], p=0.003). Pre- and postoperative NT-proBNP concentrations were closely correlated (rho=0.80, p<0.001) and postoperative NT-proBNP concentrations were also associated with long-term mortality after adjustment for EuroSCORE II. A parsimonious risk model that included age, creatinine clearance, chronic pulmonary disease, and NT-proBNP measurements provided comparable prognostic accuracy as EuroSCORE II in cohort #1 and #2 for risk of long-term mortality. hs-TnT measurements did not add to NT-proBNP measurements
NT-proBNP measurements could improve and simplify risk prediction in cardiac surgical patients.