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Brain natriuretic peptide (BNP) may play a major role in risk stratification based on cerebral oxygen saturation by near-infrared spectroscopy in patients undergoing major cardiovascular surgery

PURPOSE: A previous study reported that low baseline cerebral oxygen saturation (ScO(2)) (≤50%) measured with near-infrared spectroscopy was predictive of poor clinical outcomes after cardiac surgery. However, such findings have not been reconfirmed by others. We conducted the current study to evalu...

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Autores principales: Mukaida, Hiroshi, Hayashida, Masakazu, Matsushita, Satoshi, Yamamoto, Makiko, Nakamura, Atsushi, Amano, Atsushi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507540/
https://www.ncbi.nlm.nih.gov/pubmed/28704502
http://dx.doi.org/10.1371/journal.pone.0181154
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author Mukaida, Hiroshi
Hayashida, Masakazu
Matsushita, Satoshi
Yamamoto, Makiko
Nakamura, Atsushi
Amano, Atsushi
author_facet Mukaida, Hiroshi
Hayashida, Masakazu
Matsushita, Satoshi
Yamamoto, Makiko
Nakamura, Atsushi
Amano, Atsushi
author_sort Mukaida, Hiroshi
collection PubMed
description PURPOSE: A previous study reported that low baseline cerebral oxygen saturation (ScO(2)) (≤50%) measured with near-infrared spectroscopy was predictive of poor clinical outcomes after cardiac surgery. However, such findings have not been reconfirmed by others. We conducted the current study to evaluate whether the previous findings would be reproducible, and to explore mechanisms underlying the ScO(2)-based outcome prediction. METHODS: We retrospectively investigated 573 consecutive patients, aged 20 to 91 (mean ± standard deviation, 67.1 ± 12.8) years, who underwent major cardiovascular surgery. Preanesthetic baseline ScO(2), lowest intraoperative ScO(2), various clinical variables, and hospital mortality were examined. RESULTS: Bivariate regression analyses revealed that baseline ScO(2) correlated significantly with plasma brain natriuretic peptide concentration (BNP), hemoglobin concentration (Hgb), estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction (LVEF) (p < 0.0001 for each). Baseline ScO(2) correlated with BNP in an exponential manner, and BNP was the most significant factor influencing ScO(2). Logistic regression analyses revealed that baseline and lowest intraoperative ScO(2) values, but not relative ScO(2) decrements, were significantly associated with hospital mortality (p < 0.05), independent of the EuroSCORE (p < 0.01). Receiver operating curve analysis of ScO(2) values and hospital mortality revealed an area under the curve (AUC) of 0.715 (p < 0.01) and a cutoff value of ≤50.5% for the baseline and ScO(2), and an AUC of 0.718 (p < 0.05) and a cutoff value of ≤35% for the lowest intraoperative ScO(2). Low baseline ScO(2) (≤50%) was associated with increases in intubation time, intensive care unit stay, hospital stay, and hospital mortality. CONCLUSION: Baseline ScO(2) was reflective of severity of systemic comorbidities and was predictive of clinical outcomes after major cardiovascular surgery. ScO(2) correlated most significantly with BNP in an exponential manner, suggesting that BNP plays a major role in the ScO(2)-based outcome prediction.
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spelling pubmed-55075402017-07-25 Brain natriuretic peptide (BNP) may play a major role in risk stratification based on cerebral oxygen saturation by near-infrared spectroscopy in patients undergoing major cardiovascular surgery Mukaida, Hiroshi Hayashida, Masakazu Matsushita, Satoshi Yamamoto, Makiko Nakamura, Atsushi Amano, Atsushi PLoS One Research Article PURPOSE: A previous study reported that low baseline cerebral oxygen saturation (ScO(2)) (≤50%) measured with near-infrared spectroscopy was predictive of poor clinical outcomes after cardiac surgery. However, such findings have not been reconfirmed by others. We conducted the current study to evaluate whether the previous findings would be reproducible, and to explore mechanisms underlying the ScO(2)-based outcome prediction. METHODS: We retrospectively investigated 573 consecutive patients, aged 20 to 91 (mean ± standard deviation, 67.1 ± 12.8) years, who underwent major cardiovascular surgery. Preanesthetic baseline ScO(2), lowest intraoperative ScO(2), various clinical variables, and hospital mortality were examined. RESULTS: Bivariate regression analyses revealed that baseline ScO(2) correlated significantly with plasma brain natriuretic peptide concentration (BNP), hemoglobin concentration (Hgb), estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction (LVEF) (p < 0.0001 for each). Baseline ScO(2) correlated with BNP in an exponential manner, and BNP was the most significant factor influencing ScO(2). Logistic regression analyses revealed that baseline and lowest intraoperative ScO(2) values, but not relative ScO(2) decrements, were significantly associated with hospital mortality (p < 0.05), independent of the EuroSCORE (p < 0.01). Receiver operating curve analysis of ScO(2) values and hospital mortality revealed an area under the curve (AUC) of 0.715 (p < 0.01) and a cutoff value of ≤50.5% for the baseline and ScO(2), and an AUC of 0.718 (p < 0.05) and a cutoff value of ≤35% for the lowest intraoperative ScO(2). Low baseline ScO(2) (≤50%) was associated with increases in intubation time, intensive care unit stay, hospital stay, and hospital mortality. CONCLUSION: Baseline ScO(2) was reflective of severity of systemic comorbidities and was predictive of clinical outcomes after major cardiovascular surgery. ScO(2) correlated most significantly with BNP in an exponential manner, suggesting that BNP plays a major role in the ScO(2)-based outcome prediction. Public Library of Science 2017-07-12 /pmc/articles/PMC5507540/ /pubmed/28704502 http://dx.doi.org/10.1371/journal.pone.0181154 Text en © 2017 Mukaida et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Mukaida, Hiroshi
Hayashida, Masakazu
Matsushita, Satoshi
Yamamoto, Makiko
Nakamura, Atsushi
Amano, Atsushi
Brain natriuretic peptide (BNP) may play a major role in risk stratification based on cerebral oxygen saturation by near-infrared spectroscopy in patients undergoing major cardiovascular surgery
title Brain natriuretic peptide (BNP) may play a major role in risk stratification based on cerebral oxygen saturation by near-infrared spectroscopy in patients undergoing major cardiovascular surgery
title_full Brain natriuretic peptide (BNP) may play a major role in risk stratification based on cerebral oxygen saturation by near-infrared spectroscopy in patients undergoing major cardiovascular surgery
title_fullStr Brain natriuretic peptide (BNP) may play a major role in risk stratification based on cerebral oxygen saturation by near-infrared spectroscopy in patients undergoing major cardiovascular surgery
title_full_unstemmed Brain natriuretic peptide (BNP) may play a major role in risk stratification based on cerebral oxygen saturation by near-infrared spectroscopy in patients undergoing major cardiovascular surgery
title_short Brain natriuretic peptide (BNP) may play a major role in risk stratification based on cerebral oxygen saturation by near-infrared spectroscopy in patients undergoing major cardiovascular surgery
title_sort brain natriuretic peptide (bnp) may play a major role in risk stratification based on cerebral oxygen saturation by near-infrared spectroscopy in patients undergoing major cardiovascular surgery
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507540/
https://www.ncbi.nlm.nih.gov/pubmed/28704502
http://dx.doi.org/10.1371/journal.pone.0181154
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