The Influence of Perioperative Fluid Therapy on N-terminal-pro-brain Natriuretic Peptide and the Association With Heart and Lung Complications in Patients Undergoing Colorectal Surgery: Secondary Results of a Clinical Randomized Assessor-blinded Multicenter Trial.
Brandstrup B; Department of Surgery, Holbæk Hospital, Holbæk, Denmark.
Beier-Holgersen R; Department of Surgery, Nordsjællands Hospital Hillerød, Hillerød, Denmark.
Iversen LH; Department of Surgery, Aahus University Hospital, Aarhus C, Denmark.
Starup CB; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
Wentzel LN; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
Lindorff-Larsen K; NordSim, Aalborg University Hospital, Aalborg, Denmark.
Petersen TC; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
Tønnesen H; WHO-CC, Bispebjerg-Frederiksberg Hospital, Copenhagen University, Frederiksberg, Denmark.
Annals of surgery [Ann Surg] 2020 Dec; Vol. 272 (6), pp. 941-949.
Typ publikacji :
Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
Imprint Name(s) :
Original Publication: Philadelphia, PA : Lippincott Williams & Wilkins
MeSH Terms :
Natriuretic Peptide, Brain/*blood
Aged ; Colonic Diseases/therapy ; Digestive System Surgical Procedures ; Female ; Humans ; Male ; Middle Aged ; Perioperative Period ; Rectal Diseases/therapy ; Single-Blind Method
Brandstrup B, Tønnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens. A randomized assessor blinded multi centre trial. Ann Surg 2003; 238:641–648.
Roberts E, Ludman AJ, Dworzynski K, et al. The diagnostic accuracy of natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting. BMJ 2015; 350:1–16.
Januzzi JL, Chen-Tournoux AA, Moe G. Amino-terminal pro-B-type natriuretic peptide testing for the diagnosis or exclusion of heart failure in patients with acute symptoms. Am J Cardiol 2008; 101:29A–38A.
Chen H, Wu B, Gong D, et al. Fluid overload at start of continous renal replacement therapy is associated with poorer clinical condition and outcome: a prospective observational study on the combindes use of bioimpedance vector analysis and serum N-terminal pro-B-type natriuretic peptide measurement. Crit Care 2015; 19:135–143.
Kumar S, Khosravi M, Massart A, et al. Is there a role for N-terminal probrain-type natriuretic peptide in determining volume status in haemodialysis patients? Nephron Clin Pract 2012; 122:33–37.
Kawagoe C, Sato Y, Toida T, et al. N-terminal-pro-B-type-natriuretic peptide associated with 2-year mortality from both cardiovascular and non-cardiovascular origins in prevalent chronic hemodialysis patients. Ren Fail 2019; 40:127–134.
Ryding ADS, Kumar S, Worthington AM, et al. Prognostic value of brain natriuretic peptide in noncardiac surgery. A meta-analysis. Aneshsiology 2009; 111:311–319.
Cai GL, Chen J, Hu CB, et al. Value of plasma brain natriuretic peptide levels for predicting postoperative atrial fibrillation: a systemic review and meta-analysis. World J Surg 2014; 38:51–59.
Rodseth RN, Biccard BM, Manach YL, et al. The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery. B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: a systematic review and individual patient data meta-analysis. J Am Coll Card 2014; 63:170–180.
Karthikeyan G, Moncur RA, Levine O, et al. Is a pre-operative brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide measurement an independent predictor of adverse cardiovascular outcomes within 30 days of noncardiac surgery? J Am Coll Card 2009; 54:1599–1606.
Scrutinio D, Guido G, Guida P, et al. Combined use of high-sensitivity C-reactive protein and N-terminal pro-B-type peptide for risk stratification of vascular surgery patients. Ann Vasc Surg 2014; 28:1522–1529.
Goei D, van Kuijk JP, Flu WJ, et al. Usefulness of repeated N-terminal pro-B-type natriuretic peptide measurements as incremental predictor for longterm cardiovascular outcome after vascular surgery. Am J Cardiol 2011; 107:609–614.
Rajagopalan S, Croal BL, Reeve J, et al. N-terminal pro-B-type natriuretic peptide is an independant predictor of all-cause mortality and MACE after major vascular surgery in medium-term follow-up. Eur J Vasc Endovasc Surg 2011; 41:657–662.
Rodseth RN, Padayachee L, Biccard BM. A meta-analysis of the utility of pre-operative brain natriuretic peptide in predicting early and intermediate-term mortality and major adverse cardiac events in vacular surgical patients. Anaesthesia 2008; 63:1226–1233.
Cornell CN. CORR insights: does N-terminal pro-brain type natriuretic peptide predict cardiac complications after hip fracture surgery? Clin Orthop Relat Res 2017; 475:1737–1739.
Chong CP, Ryan JE, Van Gaal WJ, et al. Usefulness of N-terminal pro-brain natriuretic peptide to predict postoperative cardiac complications and long-term mortality after emergency lower limb orthopedic surgery. Am J Cardiol 2010; 106:865–872.
Oscarsson A, Fredrikson M, Sörliden M, et al. N-terminal fragment of pro-B-type natriuretic peptide is a predictor of cardiac events in high-risk patients undergoing acute hip fracture surgery. Br J Anaesth 2009; 103:206–212.
Manikandan R, Nathaniel C, Lewis P, et al. Tropionin T and N-terminal natriuretic peptide changes in patients undergoing transurethral resection of the prostate. J Urol 2005; 174:1892–1895.
Hou JL, Gao K, Li M, et al. Increased N-terminal pro-brain natriuretic peptide level predicts atrial fibrillation after surgery for esophageal carcinoma. World J Gastroenterol 2008; 14:2582–2585.
Kim IJ, Moon JY, Ko EJ, et al. Prognostic value of preoperative N-terminal pro-brain natriuretic peptide in non-cardiac surgery of elderly patients with normal left ventricular systolic function. Geriatr Gerontol Int 2016; 16:1109–1116.
Farzi S, Stojakovic T, Marko T, et al. Role of N-terminal pro B-type natriuretic peptide in identifying patients at high risk for adverse outcome after emergent non-cardiac surgery. Br J Anaesth 2013; 110:554–560.
Yeh HM, Lau HP, Lin JM, et al. Preoperative plasma N-terminal pro-brain natriuretic peptide as a marker of cardiac risk in patients undergoing elective non-cardiac surgery. Br J Surg 2005; 92:1041–1045.
Bihari S, Wiersema UF, Schembri D, et al. Bolus intravenous 0.9% saline, but not 4% albumin or 5% glucose, causes interstitial pulmpnary edema in helathy subjects. J Appl Physiol 2015; 119:783–792.
Lang CC, Choy AM, Turner K, et al. The effect of intravenous saline loading on plasma levels of brain natriuretic peptide in man. J Hypertens 1993; 11:737–741.
Gillies MA, Shah ASV, Mullenheim J, et al. Perioperative myocardial injury in patients receiving cardiac output-guided haemodynamic therapy: a substudy of the OPTIMISE trial. Br J Anaesth 2015; 115:227–233.
Jones E, Oliphant E, Peterson P, et al. SciPy: Open Source Scientific Tools for Python. 2001. Available at: http://www.scipy.org. Accessed April-June 2019.
Wambach G, Koch J. BNP plasma levels during acute volume expansion and chronic sodium loading in normal men. Clin Exp Hypertens 1995; 17:619–629.
Witthaut R. Science review: natriuretic peptides in critical illness. Crit Care 2004; 8:342–349.
Kanda H, Hirasaki Y, Iida T, et al. Effect of fluid loading with normal saline and 6% hydroxyethyl starch on stroke volume variability and left ventricular volume. Int J Gen Med 2015; 29:319–324.
Bark BP, Öberg CM, Grände PO. Plasma volume expansion by 0.9% NaCl during sepsis/systemic inflammatory response syndrome, after hemorrhage, and during a normal state. Shock 2013; 40:59–64.
Nordberg A, Hahn RG, Li H, et al. Population volume kinetics predicts retention of 0.9% saline infused in awake and isoflurane-anesthetized volunteers. Anesthesiology 2007; 107:24–32.
Nisanevich V, Felsenstein I, Almogy G, et al. Effect of intraoperative fluid management on outcome after intra-abdominal surgery. Anesthesiology 2005; 103:25–32.
de Aguilar-Nascimento JE, Diniz BN, do Carmo AV, et al. Clinical benefits after the implementation of a protocol of restricted perioperative intravenous crystalloid fluids in major abdominal operations. World J Surg 2009; 33:925–930.
González-Fajardo JA, Mengibar L, Brizuela JA, et al. Effect of postoperative restrictive fluid therapy in the recovery of patients with abdominal vascular surgery. Eur J Vasc Endovasc Surg 2009; 37:438–543.
Adesanya A, Rosero E, Timaran C, et al. Intraoperative fluid restriction predicts improved outcomes in major vascular surgery. Eur J Vasc Endovasc Surg 2008; 42:531–536.
Weidemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid-management strategies in acute lung injury. New Engl J Med 2006; 354:2564–2575.
Klein MB, Hayden D, Elson C, et al. The association between fluid administration and outcome following major burn: a multicenter study. Ann Surg 2007; 245:622–628.
Wuethrich PY, Burchard FC, Thalmann GN, et al. Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial. Anesthesiology 2014; 120:365–377.
Myles PS, Bellomo R, Corcoran T, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. New Engl J Med 2018; 378:2263–2274.
Yang JH, Choi JH, Ki YW, et al. Plasma N-terminal pro-B-type natriuretic peptide is predictive of perioperative cardiac events in patients undergoing vascular surgery. Korean J Intern Med 2012; 27:301–310.
Molecular Sequence :
Substance Nomenclature :
0 (Peptide Fragments)
0 (pro-brain natriuretic peptide (1-76))
114471-18-0 (Natriuretic Peptide, Brain)
Entry Date(s) :
Date Created: 20191219 Date Completed: 20210223 Latest Revision: 20210223
Update Code :
Objective: To investigate the influence of intravenous (iv) fluid volumes on the secretion of N-terminal-pro-brain natriuretic peptide (NT-Pro-BNP) in colorectal surgical patients and its association with cardiopulmonary complications (CPC). In addition, to examine if preoperative NT-Pro-BNP can predict the risk for postoperative CPC.
Methods: Blood samples from patients enrolled in a previously published clinical randomized assessor-blinded multicenter trial were analyzed. Included were adult patients undergoing elective colorectal surgery with the American-Society-of-Anesthesiologists-scores of 1-3. Samples from 135 patients were available for analysis. Patients were allocated to either a restrictive (R-group) or a standard (S-group) iv-fluid regimen, commencing preoperatively and continuing until discharge. Blood was sampled every morning until the fourth postoperative day. The primary outcome for this study was NT-Pro-BNP changes and its association with fluid therapy and CPC.
Results: The S-group received more iv-fluid than the R-group on the day-of-surgery [milliliter, median (range) 6485 (4401-10750) vs 3730 (2250-8510); P < 0.001] and on the first postoperative day. NT-Pro-BNP was elevated in the S-group compared with the R-group on all postoperative days [area under the curve: median (interquartile range) pg/mL: 3285 (1697-6179) vs 1290 (758-3719); P < 0.001 and in patients developing CPC vs no-CPC (area under the curve), median (interquartile range): 5196 (1823-9061) vs 1934 (831-5301); P = 0.005]. NT-pro-BNP increased with increasing fluid volumes all days (P < 0.003). Preoperative NT-Pro-BNP predicted CPC [odds ratio (confidence interval): 1.573 (0.973-2.541), P = 0.032; positive predictive value = 0.257, negative predictive value = 0.929].
Conclusions: NT-pro-BNP increases with iv-fluid volumes given to colorectal surgical patients, and the level of NT-Pro-BNP is associated with CPC. Preoperative NT-Pro-BNP is predictive for CPC, but the diagnostic value is low.Clinicaltrials.gov NCT03537989.