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BJA Advance Access originally published online on June 13, 2009
British Journal of Anaesthesia 2009 103(2):206-212; doi:10.1093/bja/aep139
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

N-terminal fragment of pro-B-type natriuretic peptide is a predictor of cardiac events in high-risk patients undergoing acute hip fracture surgery

A. Oscarsson1, M. Fredrikson2, M. Sörliden1, S. Anskär1 and C. Eintrei1,*

1 Division of Anaesthesia, Department of Medical and Health Sciences, Linkoping University, Sweden
2 Division of Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine, University Hospital, Linkoping, Sweden

* Corresponding author: Department of Anaesthesia and Intensive Care, University Hospital, SE-58185 Linkoping, Sweden. E-mail: christina.eintrei{at}lio.se

Background: The aim of this investigation was to assess the incidence of elevated N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) and its relation to outcome defined as perioperative adverse cardiac events and all-cause mortality in high-risk patients undergoing non-elective surgery for hip fracture.

Methods: A cohort of patients with hip fractures were extracted from a prospective observational study of high-risk patients (ASA class III or IV) undergoing emergency surgery. NT-proBNP and troponin I were measured before operation. An NT-proBNP ≥3984 ng litre–1 was set as the cut-off level for significance. Perioperative adverse cardiac events and 30 day and 3 month mortality were recorded.

Results: Sixty-nine subjects were included. Thirty-four subjects (49%) had an NT-proBNP ≥3984 ng litre–1 before surgery. Thirty-four subjects (49%) had a perioperative adverse cardiac event. Of these, 22 subjects (65%) had NT-proBNP above the diagnostic threshold compared with 12 subjects (34%) who had an NT-proBNP below the diagnostic threshold (P=0.01). Preoperative NT-proBNP ≥3984 ng litre–1 [odds ratio (OR) 3.0; 95% confidence interval (CI) 1.0–8.9] and congestive heart failure (OR 3.0; 95% CI 1.0–9.0) were independent predictors of perioperative adverse cardiac events. A total of eight subjects (12%) died within 30 days after operation.

Conclusions: There is a high incidence of elevated NT-proBNP in subjects undergoing non-elective hip fracture surgery. Preoperative NT-proBNP is a valuable predictor of cardiac complications in the perioperative period.

Keywords: complications, morbidity; heart, myocardial function; surgery, non-cardiac; surgery, orthopaedic


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The key issue of outcome after hip fracture repair lays in the early perioperative period
Anne Le Noel, et al.
British Journal of Anaesthesia, 1 Sep 2009 [Full text]

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