17 Aug 07
Preoperative plasma BNP concentrations: do they improve our care of high-risk non-cardiac surgical patients
By J. W. Sear and G. Howard-Alpe
British Journal of Anaesthesia 2007;99:151-154
There is presently much interest in the preoperative identification of high-risk patients undergoing major surgery—with the aim of adopting management strategies which may reduce postoperative morbidity and mortality. In the non-cardiac surgical patient, data for the UK suggest that there may be up to 8000 cardiovascular deaths per year for 5 million surgical procedures performed, with an incidence of 10 times that with regard to morbidity (myocardial infarction, congestive cardiac failure, malignant arrhythmias, and cardiac arrest). The major pathological disorder responsible for these adverse outcomes is ischaemic heart disease, either overt or covert, secondary to atherosclerosis. We, and others, have recently reviewed the role of biomarkers in the identification of at-risk cardiac patients.
For a test to be useful as a biomarker, it should to be able to differentiate between the ‘healthy’ and the ‘compromised’ patient. In epidemiological terms, it needs to have a high sensitivity (probability that the biomarker….