Predictive value of B-type natriuretic peptide (BNP) for adverse cardiac events in patients undergoing primary total knee arthroplasty (TKA)

Background: B-type natriuretic peptide (BNP) is a well-known biomarker to predict cardiac events following orthopedic procedures. However, further information regarding BNP can be completed. The present study aims to determine which of preoperative, postoperative or the difference between them (DVPPB) can best predict adverse cardiac events following TICA procedure and detect possible risk factors of high level of BNP. Methods: Between Jan. 2012 and Jan. 2014. 1120 included patients in 3 institutions have a minimum of 2 years follow-up. All clinical characteristics related to TKA procedure were put in total joint arthroplasty registry system and analyzed finally. The cut-off value of BNP predicting patients at increased risks of cardiac events after WA was evaluated by the Receiver Operating Characteristic (ROC) curve analysis. Results: Our results reveal DVPPB in comparison to preoperative and postoperative BNP can best predict cardiac events following primary TICA, and the optimal cut-off value was 825.5 pg/m1 with the highest Youden index of 0.62. Cigarette smoking, ASA III/IV/V, prior history of cardiac events, general anesthesia, surgery time, and tourniquet time are risk factors for DVPPB > 825.5 pg/ml. Conclusions: DVPPB in comparison to preoperative and postoperative BNP can best predict cardiac events following primary TKA. Cigarette smoking, ASA III/IV/V, prior history of cardiac events, general anesthesia, surgery time, and tourniquet time are risk factors for DVPPB > 825.5 pg/ml. We hope these results could be helpful to optimize health care among patients undergoing primary TKA. (C) 2016 Published by Elsevier B.V. on behalf of The Japanese Orthopaedic Association.