natriuretic-peptide--brain and Hip-Fractures

To investigate the clinical effects of Xinkeshu combined with levosimendan on perioperative heart failure in oldest-old patients with hip fractures.. Oldest-old patients over 80 years old with perioperative heart failure and hip fractures were randomly divided into the control and observation groups, with 50 patients in each group. All patients in both groups were treated with conventional anti-heart failure therapy and levosimendan, whereas patients in the observation group additionally received Xinkeshu tablets. Clinical manifestations; left ventricular ejection fraction (LVEF); left ventricular end-diastolic dimension (LVEDD); left ventricular end-systolic dimension (LVESD); B-type natriuretic peptide (BNP), superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide (NO), and endothelin-1 (ET-1) levels; and self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores were compared between before and after treatment to evaluate the curative effects of Xinkeshu combined with levosimendan.. After treatment, the efficacy rate was significantly higher in the observation group than in the control group. LVEF and the levels of SOD and NO were higher in the observation group than in the control group after treatment. However, LVEDD; LVESD; BNP, MDA, and ET-1 levels; and the SAS and SDS scores were lower after treatment in the observation group than in the control group.. Levosimendan combined with Xinkeshu can improve cardiac function, alleviate oxidative stress, and relieve anxiety and depression in oldest-old patients with perioperative heart failure and hip fracture.

Topics: Aged; Aged, 80 and over; Drug Therapy, Combination; Drugs, Chinese Herbal; Endothelin-1; Female; Heart Failure; Hip Fractures; Humans; Male; Malondialdehyde; Natriuretic Peptide, Brain; Nitric Oxide; Simendan; Treatment Outcome

Geriatric hip fracture patients often have increased N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels. This study found a curved association between preoperative NT-proBNP level and all-cause mortality. There was an inflection point of NT-proBNP 781 ng/L in the saturation effect. Thus, NT-proBNP was a valuable indicator of all-cause mortality.. To explore the relationship between N-terminal prohormone of brain natriuretic peptide (NT-proBNP) level and all-cause mortality in geriatric hip fractures and evaluate the possible predictive role of NT-proBNP level.. Consecutive older adult patients with hip fractures were screened between January 2015 and September 2019. Demographic and clinical characteristics of the patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between NT-proBNP levels and mortality. All analyses were performed using EmpowerStats and the R software.. One thousand three hundred fifty-four patients were included in the study. The mean follow-up was 34.35 ± 15.82 months. Four hundred twenty-nine (31.68%) patients died due to all-cause mortality. The preoperative NT-proBNP was median 337.95 (range 16.09-20,123.00) ng/L. Multivariate Cox regression models showed a nonlinearity association between NT-proBNP levels and mortality in elderly hip fractures. An NT-proBNP of 781 ng/L was an inflection point in the saturation effect. When < 781 ng/L, NT-proBNP was associated with mortality (hazard ratio [HR] = 1.12, 95% confidence interval [CI]: 1.06-1.18, P < 0.0001), whereas at > 781 ng/L, NT-proBNP was not associated with mortality (HR = 1.00, 95% CI: 0.98-1.01, P = 0.4718). In the stratification analysis, the result was stable.. The NT-proBNP levels were nonlinearly associated with mortality in elderly hip fractures, and NT-proBNP of 781 ng/L was a valuable indicator of all-cause mortality.. ChiCTR2200057323.

Topics: Aged; Biomarkers; Hip Fractures; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Proportional Hazards Models

We investigated the 90-day mortality rate in elderly patients who underwent hip fracture surgery and the association of preoperative cardiac function with mortality.. We retrospectively enrolled 133 consecutive patients aged 80 years or older who underwent hip fracture surgery. We obtained information for patient sex, age, comorbidities, medications, anesthesia method, left ventricular systolic and diastolic functions assessed by echocardiography, and preoperative brain natriuretic peptide (BNP) levels. Multivariate logistic regression analysis was performed.. The 90-day mortality rate in patients with a mean age of 88.9 years was 7.5% (10/133). More than half of the patients had diastolic dysfunction of the left ventricle. There were no significant differences in preoperative cardiac systolic and diastolic functions between the mortality group and non-mortality group. The preoperative BNP level in the mortality group was significantly higher than that in the non-mortality group (p = 0.038). Preoperative BNP level was not an independent risk factor for 90-day mortality (p = 0.081) in the primary multivariate logistic regression analysis but was an independent risk factor (p = 0.039) with an odds ratio of 1.004 (95% CI 1.000-1.008) in the sensitivity analysis with different explanatory variables.. The 90-day mortality rate in patients over 80 years old after hip fracture surgery was 7.5%. There were no significant differences in preoperative cardiac function assessed by echocardiography between the mortality and non-mortality groups. Our results suggest that there is no association or only a weak association of high BNP level with 90-day mortality in this age population.

Topics: Aged; Aged, 80 and over; Heart; Hip Fractures; Humans; Natriuretic Peptide, Brain; Retrospective Studies; Risk Factors

Osteoporotic hip fracture (OHF) is an increasingly frequent age-related pathology, which results in high rates of functional loss and mortality within the first year after surgery. This study assessed whether preoperative levels of brain natriuretic peptide (NT-proBNP) and troponin I were related to early occurrence (30d) of major adverse cardio-vascular events (MACE) after OHF repair surgery. During a 6-month period, perioperative clinical and analytical data from consecutive patients, without known history of cardiovascular disease and undergoing surgery for OHF repair at a single centre, were prospectively collected. MACE was defined as acute myocardial ischaemia or infarction, acute heart failure or cardiovascular death. amongst the 140 patients included, 23 (16.4%) developed postoperative MACE (MACE group) and 117 did not (Control group). Compared to those from control group, patients from MACE group were older, had poorer physical status (ASA III-IV), received preoperative red blood cell transfusion (RBCT) more frequently, presented with lower haemoglobin concentrations and higher NT-proBNP, creatinine and troponin I concentrations. Overall, RBCT requirements and 30d mortality rate were also higher in MACE group. However, in multivariate analysis, only preoperative RBCT, creatinine >1 mg/dL and NT-proBNP >450 pg/mL remained as independent preoperative risks factors for postoperative MACE, while 95% confidence intervals of odds ratios were wide. Though our findings require confirmation in a larger multicentre cohort, identifying risk factors for early postoperative MACE after OHF repair surgery, might facilitate assessing patients' risk prior to and following surgery, and targeting them the appropriate preventive and/or therapeutic interventions.

Topics: Aged; Aged, 80 and over; Biomarkers; Cardiovascular Diseases; Erythrocyte Transfusion; Female; Hip Fractures; Humans; Logistic Models; Male; Multivariate Analysis; Natriuretic Peptide, Brain; Osteoporotic Fractures; Peptide Fragments; Postoperative Complications; Predictive Value of Tests; Preoperative Care; Prospective Studies; Risk Assessment; Risk Factors; ROC Curve; Time Factors; Troponin I

Several studies have shown that nutrition and muscle strength were associated with functional recovery in patients with hip fracture. However, the impact of heart failure on the improvement of activity of daily living (ADL) in patients with hip fracture have not been fully investigated. The purpose was investigating the effect of heart failure on the ADL improvement by rehabilitation in patients with hip fracture. A total of 116 patients with hip fracture discharged from our convalescent rehabilitation ward were studied. Heart failure was assessed based on plasma B-type natriuretic peptide (BNP) levels on admission. ADL was assessed based on rehabilitation effectiveness (REs), which was calculated using the FIM instrument. Clinical, demographic, and nutritional variables were measured. Multiple regression analysis was performed with REs as the dependent variable; variables showing significant correlation with REs in univariate analyses were selected as independent variables. Based on plasma BNP levels, we assigned 39 patients to a Low group: 22 (17-25) median (interquartile) pg/mL, 39 to a Middle group: 52 (42-65) pg/mL, and 38 to a High group: 138 (93-209) pg/mL. REs, handgrip strength, Hb, albumin, and GNRI were higher and age was younger in the Low group than High group (each p < 0.01, respectively). Multiple linear regression analysis revealed that age (p < 0.05), sex (p < 0.05), handgrip strength (p < 0.01), FOIS at admission (p < 0.01), rehabilitation time per day (p < 0.01), and BNP (p < 0.05) were significantly associated with REs. The effect of rehabilitation on ADL improvement was significantly blunted in the High group compared to the Low group. In conclusion, these results suggest that heart failure assessed based on plasma BNP levels negatively impacts improvements in ADL achieved through rehabilitation in patients with hip fracture.

Topics: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Female; Hand Strength; Heart Failure; Hip Fractures; Humans; Linear Models; Male; Natriuretic Peptide, Brain; Nutritional Status; Retrospective Studies; Severity of Illness Index; Sex Factors; Treatment Outcome

To investigate risk factors for perioperative death in elderly patients with intertrochanteric fracture.. Clinical data from 1051 cases with intertrochanteric fracture from March 2005 to March 2015 were reviewed and analyzed, and causes of death during the perioperative period were statistically analyzed. Various indicators were compared by t test and χ. Chronic diseases of major organs (heart, brain, and lung), postoperative complications, and various indicators within 24 h after admission (albumin, hemoglobin, brain natriuretic peptide [BNP], glucose, creatinine, arterial blood pH, PaO. BNP and APACHE II score could be used as important reference indexes for predicting possible perioperative mortality in elderly patients with intertrochanteric fracture and chronic diseases of major organs. Complications after fracture may be also risk factors.

Topics: Aged; Aged, 80 and over; APACHE; Cause of Death; China; Chronic Disease; Female; Hip Fractures; Humans; Male; Natriuretic Peptide, Brain; Perioperative Period; Retrospective Studies; Risk Factors

Cardiovascular complications are common in hip fracture patients but the role of fracture type and operative method in these is unclear. This prospective cohort study aimed to evaluate the impact of fracture- and operative characteristics on perioperative cardiovascular complications and prognosis in unselected hip fracture patients.. During a 7-month trial registration period, a population of 197 consecutive hip fracture patients (median age 84 years) diagnosed with femoral neck or pertrochanteric fracture was formed. The exclusion criteria were patient refusal, subtrochanteric fracture, or death preoperatively. Pre- and postoperative troponin T (TnT) elevation, perioperative N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) level, perioperative cardiovascular adverse events, and all-cause 30-day and 2- and 5-year mortalities were studied.. Femoral neck fracture was independently associated with preoperative myocardial injury witnessed by TnT elevation (HR 2.95, 95% confidence interval 1.21-7.19, p = 0.018). The fracture type, surgery delay, or operative method were not significantly associated with NT-proBNP levels, cardiovascular adverse event diagnoses, or prognosis. Cardiovascular adverse events were clinically diagnosed in 28 (14%) participants, and these had a higher mortality compared to participants without such diagnosis (at 30 days, 32% vs 5%; 2 years, 71% vs 31%; and 5 years, 86% vs 59%; p < 0.001).. While the femoral neck fracture independently predicts preoperative cardiovascular morbidity, the operative method does not affect perioperative cardiovascular complications or the prognosis, and it may be selected by the treating clinician based on other criteria.

Topics: Aged, 80 and over; Biomarkers; Cardiovascular Diseases; Cause of Death; Female; Fracture Fixation; Hip Fractures; Humans; Length of Stay; Male; Natriuretic Peptide, Brain; Peptide Fragments; Preoperative Period; Prognosis; Prospective Studies; Risk Assessment; Troponin T

To compare effect of proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) internal fixation on serum inflammatory mediators (CRP, IL-1, IL-6 and TNF-α), myocardial injury markers (cTnT, CK-MB), and Myo-heart failure marker (BNP) in elderly patients with intertrochanteric fractures.. Experimental study.. Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, China, from January 2016 to February 2018.. A total of 114 patients with intertrochanteric fractures were randomly divided into Group A and Group B, with 57 cases in each group. Group A was treated with PFNA and Group B with DHS internal fixation. Serum CRP, IL-1, IL-6, TNF-α, cTnT, CK-MB, Myo, BNP and surgical indication were compared.. Operation time and weight-bearing time in Group A were shorter than Group B (both p<0.001). Intraoperative blood loss and postoperative drainage volume in Group A were lower than Group B (both p<0.001). On the 7ᵗʰ day after surgery, serum CRP, IL-1, IL-6, TNF-α, cTnT, CK-MB, Myo and BNP in Group A were lower than Group B (all p<0.001).. Compared with DHS, PFNA effectively reduced serum inflammatory mediators with less damage to cardiac function and myocardium in elderly patients with intertrochanteric fractures.

Topics: Age Factors; Aged; Biomarkers; Bone Nails; Bone Screws; C-Reactive Protein; Creatine Kinase, MB Form; Female; Fracture Fixation, Internal; Hip Fractures; Humans; Interleukin-1; Interleukin-6; Male; Natriuretic Peptide, Brain; Troponin T; Tumor Necrosis Factor-alpha

Hip fractures are associated with increased mortality and it is important to identify risk factors. This study demonstrates that preexisting cardiovascular disease as well as cardiovascular biomarkers that are associated with increased 30-day mortality. These findings can be used to identify high-risk patients who might benefit from specialized care.. This study investigates the association between cardiovascular disease (CVD), cardiovascular biomarkers, and 30-day mortality following a hip fracture.. The Danish National Patient Registry was used to investigate the association between CVD and mortality following hip fracture in a nationwide population-based cohort study. In a subset of the included patients (n = 355), blood samples were available from a local biobank. These samples were used for analyzing the association between specific biochemical markers and mortality. The primary outcome was 30-day mortality.. A total of 113,211 patients were included in the population-based cohort study. Among these, heart failure was present in 9.4%, ischemic heart disease in 15.9%, and ischemic stroke in 12.0%. Within 30 days after the hip fracture, 11,488 patients died, resulting in an overall 30-day mortality of 10.1%. The 30-day mortality was significantly increased in individuals with preexisting CVD with multivariably adjusted odds ratios of 1.69 (95% confidence interval, 1.60-1.78) for heart failure, 1.23 (1.17-1.29) for ischemic heart disease, and 1.06 (1.00-1.12) for ischemic stroke. In the local database including 355 patients, 41 (11.5%) died within 30 days. The multivariably adjusted odds ratio for 30-day mortality increased with increasing NT-proBNP (2.36 [1.53-3.64] per quartile) and decreased with increasing HDL cholesterol (0.58 [0.41-0.82] per quartile). On this basis, we established a model for predicting the probability of death based on the biochemical markers.. Preexisting CVD was associated with increased 30-day mortality after a hip fracture. Furthermore, high levels of NT-proBNP and low levels of HDL cholesterol were associated with increased 30-day mortality.

Topics: Aged; Aged, 80 and over; Algorithms; Biomarkers; Cardiovascular Diseases; Denmark; Female; Hip Fractures; Humans; Kaplan-Meier Estimate; Lipids; Male; Natriuretic Peptide, Brain; Odds Ratio; Osteoporotic Fractures; Peptide Fragments; Prognosis; Registries; Risk Assessment; Risk Factors; Troponin I

This prospective study included 152 elderly patients (mean age, 80 years; range, 72-88 years) with a hip fracture treated surgically. Comorbidities were evaluated, and B-type natriuretic peptide was measured at baseline and at postoperative days 4 and 5 in addition to troponin I. Major cardiac events were recorded, and 1-year mortality was assessed. Comorbidity models with the important multivariate predictors of 1-year mortality were analyzed. Overall, 9 patients (6%) experienced major cardiac events postoperatively during their hospitalization. Three patients (2%) died postoperatively, at days 5, 7, and 10, from autopsy-confirmed myocardial infarction. Three patients (2%) experienced a nonfatal myocardial infarction, and 3 patients (2%) experienced acute heart failure. At 1-year follow-up, 37 patients (24%) had died. Age older than 80 years (P=.000), renal failure (P=.016), cardiovascular disease (P=.003), respiratory disease (P=.010), Parkinson disease (P=.024), and dementia (P=.000) were univariate predictors of 1-year mortality. However, in the multivariate model, only age older than 80 years (P=.000) and dementia (P=.024) were important predictors of 1-year mortality. In all comorbidity models, age older than 80 years and dementia were important predictors of 1-year mortality. Postoperative increase in B-type natriuretic peptide was the most important predictor of 1-year mortality. Receiver operating characteristic curve analysis showed a threshold of 90 ng/mL of preoperative B-type natriuretic peptide (area under the curve=0.773, 95% confidence interval, 0.691-0.855, P<.001) had 82% sensitivity and 62% specificity to predict 1-year mortality. Similarly, a threshold of 190 ng/mL of postoperative B-type natriuretic peptide (area under the curve=0.753, 95% confidence interval, 0.662-0.844, P<.001) had 70% sensitivity and 77% specificity to predict the study endpoint. [Orthopedics. 2017; 40(3):e417-e424.].

Topics: Aged; Aged, 80 and over; Area Under Curve; Biomarkers; Cardiovascular Diseases; Comorbidity; Dementia; Female; Heart Failure; Hip Fractures; Hospital Mortality; Humans; Male; Mortality; Myocardial Infarction; Natriuretic Peptide, Brain; Postoperative Complications; Postoperative Period; Predictive Value of Tests; Prospective Studies; ROC Curve; Troponin I

Elderly patients with hip fracture are at risk for cardiac complications. N-terminal pro-brain type natriuretic peptide (NT-proBNP) has been shown to predict cardiac complications in surgical patients; however, to our knowledge, only two studies have evaluated the utility of this test in patients with hip fracture. We believe it is important to assess a more accurate cutoff value of NT-proBNP with exclusion of patients with renal failure.. To assess the association between preoperative NT-proBNP and cardiac complications after hip fracture surgery.. We performed 450 surgical procedures in patients with hip fractures between January 2011 and December 2014. Exclusion criteria were renal dysfunction and inadequate laboratory tests. The final study population consisted of 328 patients (mean age, 83 years; 80% women). Preoperatively, measurement of NT-proBNP level was performed. The primary endpoint was the occurrence of cardiac complications within 14 days after surgery based on a chart review. The predictive value of NT-proBNP was assessed using multivariate logistic regression analysis, controlling for relevant confounding variables such as age, gender, body weight, and renal function; we also performed receiver operating characteristic (ROC) curve analysis. Postoperative cardiac complications were encountered in 7% of patients (24 of 328).. The median preoperative NT-proBNP level was higher in patients with complications than in those without (1090 [interquartile range, 614-3191 pg/mL] vs 283 pg/mL [interquartile range, 137-507 pg/mL], p < 0.001). The cutoff level of NT-proBNP determined by ROC curve analysis was 600 pg/mL, with a sensitivity, specificity, positive predictive value, and negative predictive value of 79%, 81%, 25%, and 98%, respectively, and the area under the ROC curve was 0.87 (95% CI, 0.80-0.94; p < 0.001). After controlling for potentially relevant confounding variables, we found a preoperative NT-proBNP greater than 600 pg/mL was associated with an increased risk of cardiac complications (odds ratio, 13; 95% CI, 4-38; p < 0.001) compared with those with NT-proBNP less than 600 pg/mL.. Preoperative NT-proBNP greater than 600 pg/mL is independently associated with postoperative cardiac complications in patients with hip fracture without renal dysfunction. NT-proBNP measurement provides additional information and is clinically useful for predicting cardiac complications during the early phase after hip fracture surgery. Future studies might develop a simple index for prediction of postoperative cardiac complication including cutoff values of NT-proBNP.. Level III, diagnostic study.

Topics: Aged; Aged, 80 and over; Biomarkers; Female; Follow-Up Studies; Heart Diseases; Hip Fractures; Humans; Male; Natriuretic Peptide, Brain; Orthopedic Procedures; Peptide Fragments; Postoperative Complications; Predictive Value of Tests; Preoperative Period; Risk Factors; ROC Curve; Treatment Outcome

To examine the prognostic value of perioperative N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in hip fracture patients.. Blinded prospective cohort study.. Single centre trial at Turku University Hospital in Finland.. Inclusion criterion was admittance to the study hospital due to hip fracture during the trial period of October 2009--May 2010. Exclusion criteria were the patient's refusal and inadequate laboratory tests. The final study population consisted of 182 patients.. NT-proBNP was assessed once during the perioperative period and later if clinically indicated, and troponin T (TnT) and ECG recordings were evaluated repeatedly. The short-term (30-day) and long-term (1000 days) mortalities were studied.. Median (IQR) follow-up time was 3.1 (0.3) years. The median (IQR) NT-proBNP level was 1260 (2298) ng/L in preoperative and 1600 (3971) ng/L in postoperative samples (p=0.001). TnT was elevated in 66 (36%) patients, and was significantly more common in patients with higher NT-proBNP. Patients with high (>2370 ng/L) and intermediate (806-2370 ng/L) NT-proBNP level had significantly higher short-term mortality compared with patients having a low (<806 ng/L) NT-proBNP level (15 vs 11 vs 2%, p=0.04), and the long-term mortality remained higher in these patients (69% vs 49% vs 27%, p<0.001). Intermediate or high NT-proBNP level (HR 7.8, 95% CI 1.03 to 59.14, p<0.05) was the only independent predictor of short-term mortality, while intermediate or high NT-proBNP level (HR 2.27, 95% CI 1.30 to 3.96, p=0.004), the presence of dementia (HR 1.74, 95% CI 1.13 to 2.66, p=0.01) and higher preoperative American Society of Anesthesiologists' (ASA) classification (HR 1.59, 95% CI 1.06 to 2.38, p=0.02) were independent predictors of long-term mortality.. An elevated perioperative NT-proBNP level is common in hip fracture patients, and it is an independent predictor of short-term and long-term mortality superior to the commonly used clinical risk scores.. NCT01015105; Results.

Topics: Aged; Aged, 80 and over; Biomarkers; Electrocardiography; Female; Hip Fractures; Humans; Kaplan-Meier Estimate; Male; Natriuretic Peptide, Brain; Peptide Fragments; Perioperative Period; Prognosis; Prospective Studies; Risk Assessment; Troponin T

This prospective study was designed to evaluate whether preoperative plasma brain natriuretic peptide (BNP) could identify significant preoperative cardiovascular disease in elderly hip-fractured patients.. Preoperative plasma BNP measurement and rest transthoracic echocardiography (TTE) were performed within 24 h after admission in consecutive hip-fractured patients aged ≥65 years. The major echocardiographic abnormality (MEA) group included patients with at least one TTE abnormality, defined as systolic pulmonary artery pressure (PAP(s)) ≥50 mmHg, left ventricular (LV) systolic dysfunction, increased LV filling pressure (LVFP) or severe valvular disease. The control group included the remaining patients.. Seventy-five patients (mean±SD (range) age=85±5 (69-97) years) were included during a 6-month period. Twenty-four (32%) patients constituted the MEA group (17 elevated PAP(s), three LV systolic dysfunctions, 10 increased LVFP, one severe aortic stenosis and one severe mitral regurgitation). Median (interquartile) preoperative BNP value was significantly greater in MEA than in the control group (527 (361) vs. 119 (154) pg ml(-1); p<0.0001). A preoperative plasma BNP cut-off value at 285 pg ml(-1) predicted well MEA with an area under the receiver operating characteristic (ROC) curve equal to 0.895 (p<0.0001) and with a hazard ratio (HR) (confidence interval, CI) of 23.8 (3.7-142.9) (p=0.0008) on multivariate analysis. The presence of MEA or BNP≥285 pg ml(-1) was associated with high mortality.. The incidence of echocardiographic signs of elevated PAP(s) or elevated LVFP in elderly hip-fractured patients was high. A preoperative BNP value ≥285 pg ml(-1) can discriminate between elderly hip-fractured patients with or without MEA.

Topics: Aged; Aged, 80 and over; Biomarkers; Echocardiography; Female; Hip Fractures; Humans; Male; Natriuretic Peptide, Brain; Predictive Value of Tests; Preoperative Care; Prospective Studies; Reference Values; ROC Curve; Ventricular Dysfunction, Left

We investigated retrospectively the association between preoperative NT-proBNP and perioperative cardiac events in hip joint fracture surgery of the elderly.. We studied 137 patients aged >75 years who had undergone hip joint fracture surgery between April 2010 and March 2011. All patients were assigned to one of three groups; NT-proBNP<300 pg x ml(-1) of low risk group, NT-proBNP 300-1,800 pg x ml(-1) of medium risk group and NT-proBNP>1,800 pg x ml(-1) of high risk group.. Intraoperative vasopressor agents were needed significantly more in high risk group than low and medium risk groups. Moreover, postoperative hypotension and congestive heart failure occurred only in high risk group.. We demonstrated that preoperative NT-proBNP>1,800 pg x ml(-1) was related to perioperative cardiac events in hip joint fracture surgery of the elderly.

Topics: Aged, 80 and over; Female; Heart Diseases; Hip Fractures; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Perioperative Period; Postoperative Complications; Preoperative Period; Retrospective Studies

The aim of this investigation was to assess the incidence of elevated N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) and its relation to outcome defined as perioperative adverse cardiac events and all-cause mortality in high-risk patients undergoing non-elective surgery for hip fracture.. A cohort of patients with hip fractures were extracted from a prospective observational study of high-risk patients (ASA class III or IV) undergoing emergency surgery. NT-proBNP and troponin I were measured before operation. An NT-proBNP > or = 3984 ng litre(-1) was set as the cut-off level for significance. Perioperative adverse cardiac events and 30 day and 3 month mortality were recorded.. Sixty-nine subjects were included. Thirty-four subjects (49%) had an NT-proBNP > or = 3984 ng litre(-1) before surgery. Thirty-four subjects (49%) had a perioperative adverse cardiac event. Of these, 22 subjects (65%) had NT-proBNP above the diagnostic threshold compared with 12 subjects (34%) who had an NT-proBNP below the diagnostic threshold (P=0.01). Preoperative NT-proBNP > or = 3984 ng litre(-1) [odds ratio (OR) 3.0; 95% confidence interval (CI) 1.0-8.9] and congestive heart failure (OR 3.0; 95% CI 1.0-9.0) were independent predictors of perioperative adverse cardiac events. A total of eight subjects (12%) died within 30 days after operation.. There is a high incidence of elevated NT-proBNP in subjects undergoing non-elective hip fracture surgery. Preoperative NT-proBNP is a valuable predictor of cardiac complications in the perioperative period.

Topics: Aged; Aged, 80 and over; Biomarkers; Cardiovascular Diseases; Emergencies; Female; Hip Fractures; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Postoperative Complications; Preoperative Care; Prognosis; Prospective Studies