THE UTILITY OF NT-PROBNP TO PREDICT POST-CARDIAC SURGERY RISK OF DEVELOPING ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Brain natriuretic peptide (BNP) may have the ability to predict postoperative atrial fibrillation. Our objective was to evaluate the usefulness of postoperative N-Terminal-proBNP (NT-proBNP) as an independent factor to predict post-cardiac surgery atrial fibrillation (POAF). We developed a comprehensive search strategy including Medline, Embase, and Cochrane databases. Studies were eligible if they met the following inclusion criteria: adult patients (≥18 years old), cardiac surgery, measured post-operative NT-proBNP, and atrial fibrillation was one of the measured endpoints. We excluded studies that assessed only preoperative BNP, non-cardiac surgeries, case reports, guidelines, comments, e-comments, and abstracts. Four studies were identified as eligible the systematic review with a total of 613 patients and two had sufficient data to be included in the meta-analysis with total of 339 patients. A random effects model was used for the meta-analysis. Patients developing POAF had a statistically significant increase in NT-proBNP levels compared to the cohort of patients who did not develop POAF (weighted mean difference 1770 pg/mL [95% CI 568 to 2971], P = 0.004). Insufficient data was available for meta-analysis of the sensitivity and specificity of various cut-offs of NT-proBNP levels. Although the data available is limited and originating from observational studies with the potential for bias, NT-proBNP has been shown to predict POAF. Future studies should further assess the sensitivity and specificity of various cut-offs of post-operative NT-proBNP for prediction of POAF.