Brain natriuretic peptide (BNP)markers can be useful
to monitor heart failure patients, kidney disease,
lungs and liver disease. BNP is a peptide that regulates
fluid balance and blood pressure. Higher BNP usually means
intracardiac pressure.
The study below, included patients <50 years, for spinal anesthesia
undergoing knee replacement or hip replacement surgery.
Patients were injected with hyperbaric bupivacaine or obaric levobupivacaine.
The study concludes that pre-op level of BNP is a useful marker
for post-op cardiac events.
Interesting to note that patients with pre-op BNP of >40 pg/mL
were five times more likely to develop new cardiac events.
Considered normal range for male aged 50 years: 10-59 pg/mL
Elderly or frail patients may be useful to ask the on duty anesthesiologist
to take your BNP level pre-operatively.
Prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of B-type natriuretic peptide, the revised cardiac risk index, and ASA classLuigi Vetrugno, Nicola Langiano, Renato Gisonni, Alessandro Rizzardo, Paola Enrica Venchiarutti, Michele Divella, Livia Pompei, Araldo Causero and Giorgio Della Rocca
BMC Anesthesiology 2014, 14:20 doi:10.1186/1471-2253-14-20
Published: 21 March 2014
Abstract (provisional)
Background
The aim of this study was to evaluate pre- and post-operative brain natriuretic peptide (BNP) levels and compare the power of this test in predicting in-hospital major adverse cardiac events (MACE: atrial fibrillation, flutter, acute heart failure or non-fatal/fatal myocardial infarction) in patients undergoing elective prosthesis orthopedic surgery to that of the Revised Cardiac Risk Index (RCRI) and American Society of Anesthesiology (ASA) class, the most useful scores identified to date.
Methods
The study was an observational study of consecutive patients undergoing elective prosthesis orthopedic surgery. Surgical risk was established using RCRI score and ASA class criteria. Venous blood was sampled before surgery and on postoperative day 1 for the measurement of BNP. The intraoperative data collected included details of the surgery and anesthesia and any MACE experienced up until hospital discharge.
Results
MACE occurred in 14 of the 227 patients treated (6.2%). Age was statistical associated with MACE (p < 0.004). Preoperative BNP levels were higher (p < 0.0007) in patients who experienced MACE than in event-free patients (median values: 92 and 35 pg/mL, respectively). Postoperative BNP levels were also greater (p < 0.0001) in patients sustaining MACE than in event-free patients (median values: 165 and 45 pg/mL, respectively). ROC curve analysis demonstrated that for a cut-off point >= 39 pg/mL, the area under the curve for preoperative BNP was equal to 0.77, while a postoperative BNP cut-off point >= 69 pg/mL gave an AUC of 0.82.
Conclusions
Both pre- and post-operative BNP concentrations are predictors of MACE in patients undergoing elective prosthesis orthopedic surgery.
www.biomedcentral.com/1471-2253/14/20/abstract