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
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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, Birgitte; Beier-Holgersen, Randi; Iversen, Lene H.; Starup, Christian B.; Wentzel, Loui N.; Lindorff-Larsen, Karen; Petersen, Troels C.; Tonnesen, Hanne.
In: Annals of Surgery, Vol. 272, No. 6, 01.12.2020, p. 941-949.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - 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
AU - Brandstrup, Birgitte
AU - Beier-Holgersen, Randi
AU - Iversen, Lene H.
AU - Starup, Christian B.
AU - Wentzel, Loui N.
AU - Lindorff-Larsen, Karen
AU - Petersen, Troels C.
AU - Tonnesen, Hanne
PY - 2020/12/1
Y1 - 2020/12/1
N2 - 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.(1) 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.
AB - 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.(1) 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.
KW - cardiac complications
KW - colorectal surgery
KW - complications
KW - complications after surgery
KW - fluid therapy
KW - gastrointestinal surgery
KW - hormones
KW - intravenous fluid
KW - NT-pro-BNP
KW - restricted fluid
KW - surgery
U2 - 10.1097/SLA.0000000000003724
DO - 10.1097/SLA.0000000000003724
M3 - Journal article
C2 - 31850996
VL - 272
SP - 941
EP - 949
JO - Advances in Surgery
JF - Advances in Surgery
SN - 0003-4932
IS - 6
ER -
ID: 256934072