ABSTRACT
Abstract Objective: We evaluated whether the preoperative serum concentration of brain natriuretic peptide (BNP) is a predictor of in-hospital mortality in patients that underwent cardiac surgery. Methods: We continuously evaluated 488 patients that underwent cardiac valve surgery or coronary artery bypass grafting (CABG) between January of 2009 and July of 2012. Follow up of these patients were done prospectively for 30 days postoperatively. Results: Data analysis showed that the overall mortality rate was equal to 9.6%, Receiver Operating Charactheristic (ROC) curve analysis found the optimal cut-off value of BNP equal to 382 pg/mL for overall mortality (AUC=0.73, 95% CI=0.66 to 0.81, P<0.001). Multivariate analysis showed that the value of BNP higher than 382 pg/mL (P=0.033, HR=2.05, 95% CI=1.6 to 3.98) was an independent predictor of overall mortality at 30 days postoperatively. Conclusion: We concluded that the preoperative serum concentration of BNP is an independent predictor of mortality in patients undergoing valve surgery or coronary artery bypass graft. .
Resumo Objetivo: Avaliar se a concentração sérica pré-operatória de peptídeo natriurético cerebral tipo B (BNP) é preditora de mortalidade intra-hospitalar em pacientes submetidos à cirurgia cardíaca. Métodos: Foram avaliados 488 pacientes consecutivamente submetidos à cirurgia cardíaca valvar ou à cirurgia de revascularização do miocárdio no período de janeiro de 2009 a julho de 2012. Estes foram seguidos, prospectivamente, por 30 dias de pós-operatório. Resultados: Em nossa casuística, a mortalidade geral foi igual a 9,6% e 52% dos pacientes foram submetidos a cirurgia de revascularização do miocárdio. Análise de curva ROC (Receiver Operating Charactheristic) encontrou o valor de corte ótimo de BNP igual a 382 pg/mL para mortalidade geral (AUC=0,73, IC95%=0.66 a 0,81, P<0.001). Análise multivariada mostrou que o valor de BNP > 382 pg/mL (P=0,033, HR=2,05, IC 95%=1,06 a 3,98) foi preditor independente de mortalidade geral em 30 dias de pós-operatório. Conclusão: A concentração sérica pré-operatória do BNP é um preditor independente de mortalidade em pacientes submetidos à cirurgia valvar ou de revascularização do miocárdio. .
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Coronary Artery Bypass/mortality , Hospital Mortality , Heart Valve Diseases/mortality , Heart Valve Diseases/surgery , Natriuretic Peptide, Brain/blood , Biomarkers/blood , Epidemiologic Methods , Postoperative Period , Reference Values , Risk Assessment/methods , Time Factors , Treatment OutcomeABSTRACT
Objective To explore method of early diagnosis and treatment of adult patients with cerebral ischemic stroke after cardiovascular surgery.Methods The chnical data of 24 adult patients with cerebral ischemic stroke after cardiovascular surgery were retrospectively analyzed.Firstly,CT or MRI should be accomplished to determine the type of cerebral ischemic stroke as soon as patients' condition of circulation and respiration were stable.Secondly,the vital signs should be monitored closely,and the consciousness,pupil,respiratory and hmbs activity of the patients were observed.Thirdly,the patients' temperature of head should be reduced and be given dehydration,anticoagulation,cholesterol-lowering medication,brain nutrition drugs,beta receptor blockers and other drugs.Overall,the balance of fluid,electrolytes and acid-base were maintained in the course of treatment.Results Among the 24 patients,male was 66.7％ (16/24).Early cerebral ischemic stroke occurred in 6 cases,delayed cerebral ischemic stroke occurred in 18 cases.Cerebral ischemic stroke happened in 12 patients who underwent coronary artery bypass grafting surgery,8 patients after cardiac valve replacement surgery,2 cases after artery dissection surgery and 2 patients after other surgery.Two cases were death during hospital stay,the mortality was 8.3％ (2/24).Conclusion Adult patients with clinical manifestation of cerebral ischemic stroke after cardiovascular surgery should be diagnosed early as soon as possible,the treatment key of cerebral ischemic stroke is strict monitoring and comprehensive treatment.