Comparison of preoperative NT-proBNP and simple cardiac risk scores for predicting postoperative morbidity after non-cardiac surgery with intermediate or high surgical risk

Götz Schmidt; Nora Frieling; Emmanuel Schneck; Marit Habicher; Christian Koch; Birgit Aßmus; Michael Sander

doi:10.1186/s13741-024-00400-z

Comparison of preoperative NT-proBNP and simple cardiac risk scores for predicting postoperative morbidity after non-cardiac surgery with intermediate or high surgical risk

Perioper Med (Lond). 2024 May 17;13(1):44. doi: 10.1186/s13741-024-00400-z.

Authors

Götz Schmidt¹, Nora Frieling², Emmanuel Schneck², Marit Habicher², Christian Koch², Birgit Aßmus^#³, Michael Sander^#²

Affiliations

¹ Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University Giessen, Rudolf-Buchheim-Strasse 7, Giessen, 35392, Germany. Goetz.F.Schmidt@chiru.med.uni-giessen.de.
² Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University Giessen, Rudolf-Buchheim-Strasse 7, Giessen, 35392, Germany.
³ Department of Cardiology and Angiology, Justus Liebig University of Giessen, Klinikstrasse 33, Giessen, 35392, Germany.

^# Contributed equally.

Abstract

Background: Chronic heart failure (HF) is frequent in elderly patients undergoing non-cardiac surgery. Preoperative risk stratification is vital and can be achieved using simple clinical risk scores or preoperative N-terminal prohormone of brain natriuretic peptide (NT-proBNP) measurement. This study aimed to compare the predictivity of the revised cardiac risk index (RCRI), the American University of Beirut cardiovascular risk index (AUB-HAS2), and a score proposed by Andersson et al. for postoperative 30-day morbidity to preoperative NT-proBNP.

Methods: Preoperative NT-proBNP was measured in 199 consecutive patients aged ≥ 65 years undergoing elective non-cardiac surgery with intermediate or high surgical risk. The areas under the receiver operating characteristic curve (AUCROC) for the composite morbidity endpoint (CME) comprising the incidence of any rehospitalisation, acute decompensated HF, acute kidney injury, and any infection at postoperative day 30 were assessed. Multivariable logistic regression analysis derived new scores from the simple risk scores and the NT-proBNP cut-off of 450 pg/mL.

Results: AUB-HAS2, but not RCRI or Andersson score, significantly predicted the CME (AUB-HAS2: AUCROC 0.646, p < 0.001; RCRI: AUCROC 0.560, p = 0.126; Andersson: AUCROC 0.487, p = 0.760). The AUCROC was comparable between preoperative NT-proBNP (0.679, p < 0.001) and AUB-HAS2 (p = 0.334). Multivariable analyses revealed a preoperative NT-proBNP ≥ 450 pg/mL to be the strongest predictor of CME among the individual score components (p < 0.001). Adding preoperative NT-proBNP improved the predictive value of AUB-HAS2 and RCRI (modified AUB-HAS2: AUCROC 0.703, p < 0.001; modified RCRI: AUCROC 0.679, p < 0.001; both p < 0.001 vs original scores). The predictive value of the modified RCRI and AUB-HAS2 was comparable to preoperative NT-proBNP alone (p = 0.988 vs modified RCRI, p = 0.367 vs modified AUB-HAS2).

Conclusions: The predictive value of postoperative morbidity varies significantly between the available simple perioperative risk scores and can be enhanced by preoperative NT-proBNP. New scores, including preoperative NT-proBNP, should be evaluated in large multicentre cohorts.

Trial registration: German Clinical Trials Register: DRKS00027871.

Keywords: AUB-HAS2; Acute decompensated heart failure; Acute kidney injury; Brain natriuretic peptide; Perioperative; Rehospitalisation; Revised cardiac risk index.

Abstract

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