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NATRIURETIC PEPTIDES as Prognostic Markers for Delirium in Cardiac Surgery
Delirium is a common complication following cardiac surgery and is associated with increased long-term cognitive dysfunction. It is estimated to have an incidence up to 52%. Natriuretic peptides have shown to worsen the disruption of the blood-brain barrier and thus promote delirium. Using the Biomedica NT-proCNP ELISA a team of researchers investigated atrial natriuretic peptide (ANP) and C-type natriuretic peptide (CNP) as prognostic markers for delirium in cardiac surgery. Learn more .
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Abstract:
Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery—A Pilot Study. Saller T, Peterss S, Scheiermann P, Eser-Valeri D, Ehler J, Bruegger D, Chappell D, Kofler O, Hagl C, Hofmann-Kiefer K. Medicina (Kaunas). 2020. 56(6):258. doi: 10.3390/medicina56060258. PMID: 32471143; PMCID: PMC7353880.
Background and Objectives: Delirium is a common and major complication subsequent to cardiac surgery. Despite scientific efforts, there are no parameters which reliably predict postoperative delirium. In delirium pathology, natriuretic peptides (NPs) interfere with the blood–brain barrier and thus promote delirium. Therefore, we aimed to assess whether NPs may predict postoperative delirium and long-term outcomes. Materials and Methods: To evaluate the predictive value of NPs for delirium we retrospectively analyzed data from a prospective, randomized study for serum levels of atrial natriuretic peptide (ANP) and the precursor of C-type natriuretic peptide (NT-proCNP) in patients undergoing coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (off-pump coronary bypass grafting; OPCAB). Delirium was assessed by a validated chart-based method. Long-term outcomes were assessed 10 years after surgery by a telephone interview. Results: The overall incidence of delirium in the total cohort was 48% regardless of the surgical approach (CABG vs. OPCAB). Serum ANP levels > 64.6 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 100% (75.3–100) and specificity of 42.9% (17.7–71.1). Serum NT-proCNP levels >1.7 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 92.3% (64.0–99.8) and specificity of 42.9% (17.7–71.1). Both NPs could not predict postoperative survival or long-term cognitive decline. Conclusions: We found a positive correlation between delirium and preoperative plasma levels of ANP and NT-proCNP. A well-powered and prospective study might identify NPs as biomarkers indicating the risk of delirium and postoperative cognitive decline in patients at risk for postoperative delirium.
Related publications:
The predictive value of preoperative natriuretic peptide concentrations in adults undergoing surgery: a systematic review and meta-analysis. Lurati Buse GA, Koller MT, Burkhart C, Seeberger MD, Filipovic M. Anesth Analg. 2011. 112(5):1019-33. doi: 10.1213/ANE.0b013e31820f286f. PMID: 21372274.
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