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Preoperative serum brain natriuretic peptide and risk of acute kidney injury after cardiac surgery.

Publication ,  Journal Article
Patel, UD; Garg, AX; Krumholz, HM; Shlipak, MG; Coca, SG; Sint, K; Thiessen-Philbrook, H; Koyner, JL; Swaminathan, M; Passik, CS; Parikh, CR ...
Published in: Circulation
March 20, 2012

BACKGROUND: Acute kidney injury (AKI) after cardiac surgery is associated with poor outcomes and is difficult to predict. We conducted a prospective study to evaluate whether preoperative brain natriuretic peptide (BNP) levels predict postoperative AKI among patients undergoing cardiac surgery. METHODS AND RESULTS: The Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) study enrolled 1139 adults undergoing cardiac surgery at 6 hospitals from 2007 to 2009 who were selected for high AKI risk. Preoperative BNP was categorized into quintiles. AKI was common with the use of Acute Kidney Injury Network definitions; at least mild AKI was a ≥0.3-mg/dL or 50% rise in creatinine (n=407, 36%), and severe AKI was either a doubling of creatinine or the requirement of acute renal replacement therapy (n=58, 5.1%). In analyses adjusted for preoperative characteristics, preoperative BNP was a strong and independent predictor of mild and severe AKI. Compared with the lowest BNP quintile, the highest quintile had significantly higher risk of at least mild AKI (risk ratio, 1.87; 95% confidence interval, 1.40-2.49) and severe AKI (risk ratio, 3.17; 95% confidence interval, 1.06-9.48). After adjustment for clinical predictors, the addition of BNP improved the area under the curve to predict at least mild AKI (0.67-0.69; P=0.02) and severe AKI (0.73-0.75; P=0.11). Compared with clinical parameters alone, BNP modestly improved risk prediction of AKI cases into lower and higher risk (continuous net reclassification index; at least mild AKI: risk ratio, 0.183; 95% confidence interval, 0.061-0.314; severe AKI: risk ratio, 0.231; 95% confidence interval, 0.067-0.506). CONCLUSIONS: Preoperative BNP level is associated with postoperative AKI in high-risk patients undergoing cardiac surgery. If confirmed in other types of patients and surgeries, preoperative BNP may be a valuable component of future efforts to improve preoperative risk stratification and discrimination among surgical candidates.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

March 20, 2012

Volume

125

Issue

11

Start / End Page

1347 / 1355

Location

United States

Related Subject Headings

  • Risk Factors
  • Prospective Studies
  • Preoperative Care
  • Postoperative Complications
  • Natriuretic Peptide, Brain
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cohort Studies
 

Citation

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Patel, U. D., Garg, A. X., Krumholz, H. M., Shlipak, M. G., Coca, S. G., Sint, K., … Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) Consortium. (2012). Preoperative serum brain natriuretic peptide and risk of acute kidney injury after cardiac surgery. Circulation, 125(11), 1347–1355. https://doi.org/10.1161/CIRCULATIONAHA.111.029686
Patel, Uptal D., Amit X. Garg, Harlan M. Krumholz, Michael G. Shlipak, Steven G. Coca, Kyaw Sint, Heather Thiessen-Philbrook, et al. “Preoperative serum brain natriuretic peptide and risk of acute kidney injury after cardiac surgery.Circulation 125, no. 11 (March 20, 2012): 1347–55. https://doi.org/10.1161/CIRCULATIONAHA.111.029686.
Patel UD, Garg AX, Krumholz HM, Shlipak MG, Coca SG, Sint K, et al. Preoperative serum brain natriuretic peptide and risk of acute kidney injury after cardiac surgery. Circulation. 2012 Mar 20;125(11):1347–55.
Patel, Uptal D., et al. “Preoperative serum brain natriuretic peptide and risk of acute kidney injury after cardiac surgery.Circulation, vol. 125, no. 11, Mar. 2012, pp. 1347–55. Pubmed, doi:10.1161/CIRCULATIONAHA.111.029686.
Patel UD, Garg AX, Krumholz HM, Shlipak MG, Coca SG, Sint K, Thiessen-Philbrook H, Koyner JL, Swaminathan M, Passik CS, Parikh CR, Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) Consortium. Preoperative serum brain natriuretic peptide and risk of acute kidney injury after cardiac surgery. Circulation. 2012 Mar 20;125(11):1347–1355.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

March 20, 2012

Volume

125

Issue

11

Start / End Page

1347 / 1355

Location

United States

Related Subject Headings

  • Risk Factors
  • Prospective Studies
  • Preoperative Care
  • Postoperative Complications
  • Natriuretic Peptide, Brain
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cohort Studies