The Role of the N-Terminal of the Prohormone Brain Natriuretic Peptide in Predicting Postoperative Multiple Organ Dysfunction Syndrome

Abstract

Background: Multiple organ dysfunction syndrome (MODS) is the progressive and potentially reversible dysfunction of at least two organ systems in the course of an acute and life-threatening disorder of systemic homeostasis. MODS is a serious post-cardiac-surgery complication in valvular heart disease that is associated with a high risk of death. This study assessed the predictive ability of selected preoperative and perioperative parameters for the occurrence of MODS in the early postoperative period in a group of patients with severe valvular heart disease. Methods: Subsequent patients with significant symptomatic valvular heart disease who underwent cardiac surgery were recruited in the study. The main end-point was postoperative MODS, defined as a dysfunction of at least two organs—perioperative stroke, heart failure requiring mechanical circulatory support, respiratory failure requiring mechanical ventilation, and postoperative acute kidney injury requiring renal replacement therapy. A logistic regression was used to assess relationships between variables. Results: There were 602 patients recruited for this study. The main end-point occurred in 40 patients. Preoperative NT-proBNP (OR 1.026; 95% CI 1.012–1.041; p = 0.001) and hemoglobin (OR 0.653; 95% CI 0.503–0.847; p = 0.003) are independent predictors of the primary end-point in a multivariate regression analysis. The cut-off point for the NT-proBNP value for postoperative MODS was calculated at 1300 pg/mL. Conclusions: A high preoperative level of NTpro-BNP may be associated with the onset of MODS in the early postoperative period. The results of the study may also suggest that earlier cardiac surgery for significant valvular heart disease may be associated with an improved prognosis in this group of patients.

Minimally Invasive Trans-Axillary versus Full Sternotomy Mitral Valve Repair: A Propensity Score-Matched Analysis on Mid-Term Outcomes

“…Overall survival was excellent; 5-year survival was 98.8% in the TAxA cohort and 93.6% in the FS cohort, similar to previous reports [4,27,28]. This finding is not surprising since our population included patients who were young/middle-aged with few comorbidities, suffering generally from degenerative mitral valve disease and operated on an earlier stage of heart failure [29]. In our cohorts, the need for mitral valve reoperation was very low: the cumulative incidence of reoperation was 2.6% and 4.4% at 5 years, respectively, in TAxA and FS cohorts, considering death as a competing risk.…”

Usefulness of the N-Terminal of the Prohormone Brain Natriuretic Peptide in Predicting Acute Kidney Injury Requiring Renal Replacement Therapy in Patients Undergoing Heart Valve Surgery

“…Heart failure is a common disease entity observed in patients with postoperative AKI requiring renal replacement therapy in the early period after heart valve surgery [21][22][23]. In the above study, out of 50 patients who underwent continuous renal replacement therapy (CRRT) in the form of hemodiafiltration, 45 patients had persistent postoperative hemodynamic instability requiring prolonged administration of catecholamines, and 11 of the patients mentioned above required additional mechanical support due to the development of post-cardiotomy shock in the form of ECMO or IABP.…”

Nomogram and Risk Calculator for Postoperative Tracheostomy after Heart Valve Surgery

“…First, this was a single-center study and was not validated externally in an independent dataset, which may limit the generalizability of our findings. Second, some possible risk factors, such as the N-terminal fragment of B-type natriuretic propeptide [ 46 ], were not collected and included in our analysis, even though the established model performed well. Third, the data we collected were limited to hospitalization, and long-term prognoses after discharge were not followed or analyzed, which needs to be strengthened in future studies.…”