Abstract
Increased N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration predicts poor prognosis of non-CNS cancer patients. We evaluated the association of NT-proBNP concentration with disease severity, discharge outcomes and prognosis of patients undergoing craniotomy for brain tumor. From January, 2010 until September, 2011 two-hundred and forty-five patients (age 55.05 ± 14.62 years) admitted for brain tumor surgery were evaluated for NT-proBNP serum concentration. Outcome at hospital discharge was evaluated with the Glasgow Outcome Scale (GOS). Most common diagnoses were meningioma (37%) and high-grade glioma (20%). Greater NT-proBNP concentration was associated with lower Barthel index (rho = −0.305, p = 0.001) and Mini Mental State Examination scores (rho = −0.314, p = 0.001) and with greater Hospital Anxiety and Depression scale Depression score (rho = 0.240, p = 0.026). Greater admission NT-proBNP concentration was associated with lower discharge GOS score after adjusting for patient age, gender and histological brain tumor diagnosis (β = −0.253, p < 0.001). Greater NT-proBNP concentration was also associated with greater 5-year mortality risk (HR = 1.845; 95%CI [1.166–2.920], p = 0.009) controlling for patient age, gender, history of cardiovascular disease, histological diagnosis and adjuvant therapy. In sum, greater pre-operative NT-proBNP concentration is associated with worse health status, unfavorable discharge outcome and shorter survival of brain tumor patients.
Highlights
N-terminal pro-B-type natriuretic peptide (NT-proBNP) is produced by ventricular cardiomyocytes in response to volume or pressure overload[1]
There are no studies evaluating possible clinical value of pre-operative NT-proBNP assessment for peri-operative risk stratification of patients undergoing elective surgery for brain tumors. In this prospective observational cohort study we aimed to evaluate the association of pre-operative NT-proBNP serum concentration with disease severity, discharge outcomes and prognosis of brain tumor patients undergoing elective craniotomy
We found that elevated serum NT-proBNP concentrations were common to high-grade glioma, meningioma and metastatic brain tumor patients, and were associated with greater patient age and histories of cardiovascular disease
Summary
N-terminal pro-B-type natriuretic peptide (NT-proBNP) is produced by ventricular cardiomyocytes in response to volume or pressure overload[1]. Biological mechanisms underlying the increased production of NT-proBNP in cancer setting remain poorly understood, but it was demonstrated that greater concentration of NT-proBNP and other biomarkers of myocardial damage are associated with worse prognosis and shorter survival of cancer patients not receiving cardio-toxic chemotherapy[10]. These findings suggest that subclinical dysfunction of the cardiovascular system is common and has prognostic significance in cancer patients. There are no studies evaluating possible clinical value of pre-operative NT-proBNP assessment for peri-operative risk stratification of patients undergoing elective surgery for brain tumors
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