Abstract
Objective: The present meta-analysis was aimed to systematically evaluate the effectiveness and accuracy of brain natriuretic peptide (BNP), cardiac troponin (cTn), high sensitive C reactive protein (hs-CRP) and CRP for predicting postoperative major adverse cardiovascular events (MACE) in patients undergoing noncardiac surgery.Methods: A total of 26 relevant studies with 7,877 participants were collected from five databases, namely PubMed, Embase, China National Knowledge Infrastructure (CNKI), CQVIP and the Wanfang Database until August 10, 2018. And the Review Manager Version 5.3 and Stata/SE 12 software were used for data syntheses in the meta-analysis.Results: Strong relationships of BNP/NT-proBNP, cTnI/cTnT and hs-CRP with MACE were detected in patients undergoing noncardiac surgery, and the five biomarkers all increased the risk of MACE. Compared to normal levels, elevated BNP/NT-proBNP could increase the MACE risk by almost 4-fold [RR:3.92, 95%CI: 3.23–4.75, P < 0.001]; elevated BNP corresponded to a 4.5-fold risk [RR:4.57, 95%CI: 3.37–6.20, P < 0.001]; elevated NT-proBNP led to a 3-fold higher risk [RR:3.48, 95%CI: 2.71–4.46, P < 0.001]. Comparing with normal levels of cTnI/cTnT, increased cTnI/cTnT was associated with nearly 5-fold more higher risk of MACE [RR:5.52, 95%CI: 4.62–6.58, P < 0.001]; elevated cTnI faced a 5-fold risk [RR:5.21, 95%CI: 3.96–6.86, P < 0.001]; elevated cTnT resulted in nearly 6-fold higher risk [RR:5.73, 95%CI: 4.55–7.22, P < 0.001]. The elevation of hs-CRP was associated with nearly 4-fold higher risk of MACE in comparison with normal concentration [RR:3.73, 95%CI: 2.63–5.30, P < 0.001].Conclusion: According to the results of our meta-analysis, the elevations of BNP/NT-proBNP, cTnI/cTnT, and hs-CRP, pre-operation or post-operation immediately, can predict much higher risk of postoperative MACE in patients undergoing noncardiac surgery.
Highlights
The rate of perioperative events shows a declining tendency in the past 30 years, a consequence of the developments in anesthesiology and surgical techniques, cardiovascular complications still represent a leading cause of perioperative mortality in individuals receiving large noncardiac surgery (Devereaux et al, 2005)
We methodically searched the databases of PubMed, Embase, China National Knowledge Infrastructure (CNKI), VIP China Science, and Wanfang with the combination of the following search keywords: “b-type natriuretic peptide” or “Natriuretic Peptide, Brain” or “high-sensitivity C reactive protein” or “hsCRP” or “C reactive protein” or “C-reactive protein (CRP)” or “Troponin.” “cardiac events” or “cardiovascular events” or “major adverse cardiac events,” and “surgery.” Publication languages were limited to English and Chinese only
Of the remaining 153 papers, 26 articles were considered to be eligible for our study after reading the full texts, and the other 127 articles were excluded for the following reasons: multiple results from the same study (n = 34), not cohort studies (n = 11), negative results (n = 2), cardiac surgery (n = 21), low quality (n = 4), incomplete data (n = 54), only 1 article for CRP, so we excluded it (n = 1). (Figure 1)
Summary
The rate of perioperative events shows a declining tendency in the past 30 years, a consequence of the developments in anesthesiology and surgical techniques, cardiovascular complications still represent a leading cause of perioperative mortality in individuals receiving large noncardiac surgery (Devereaux et al, 2005). Biomarkers may help to reduce the morbidity rate of major adverse cardiovascular event (MACE, including death, stroke, myocardial infarction, and need for coronary artery bypass graft or percutaneous coronary intervention) during perioperative and postoperative period. Cardiac biomarkers, such as brain natriuretic peptide (BNP) and amino-terminal pro-hormone of brain natriuretic peptide (NT-proBNP), cardiac troponins (cTn), high sensitive C reactive protein (hs-CRP) and CRP, are currently considered to play a pivotal role in evaluating treatment strategy and prognosis of different cardiac diseases (McMurray et al, 2012; Clerico et al, 2014; Thygesen et al, 2018). BNP would increase during exercise in patients without heart failure and healthy individuals, resulting from transient myocardial wall stress, cardiomyocyte metabolic changes, and neuroendocrinology response (Hamasaki, 2016)
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