N-terminal Pro-brain Natriuretic Peptide as a Prognostic Biomarker for Cardiac Surgeries: A Systematic Review

INTRODUCTION: N-terminal pro-brain natriuretic peptide (NT-proBNP) is a biomarker for heart stress and heart failure, with its production triggered by the stretching of cardiac fibers. This study investigates if elevated NT-proBNP levels can independently predict poor outcomes for patients undergoing heart surgery. METHODS: A systematic review was performed in the PubMed®, Latin American and Caribbean Health Sciences Literature (or LILACS), Physiotherapy Evidence Database (PEDro), Web of Science, and Embase databases, with the following descriptors: "NT-proBNP" OR "NTproBNP" OR "N- terminal pro-B-type natriuretic peptide" OR "N- terminal pro brain natriuretic peptide" OR "amino terminal pro brain natriuretic peptide" AND "Cardiovascular Surgical Procedures" NOT "Pediatric" OR "children" NOT "cancer" OR "oncology" NOT "animal*". Articles that evaluated NT-proBNP and adverse outcomes in cardiac surgical patients were chosen. The levels of evidence and the strength of recommendation were assessed considering the Grading of Recommendations, Assessment, Development and Evaluation (or GRADE) system and validity by the PEDro scale. For systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (or PRISMA) criteria and the Population, Intervention, Comparison, Outcome (or PICO) strategy were followed. RESULTS: Forty-seven articles were included, of which 17 were related to serious complications, including mortality. CONCLUSION: Preoperative NT-proBNP is a prognostic marker for mortality, length of stay in the postoperative intensive care unit, postoperative acute kidney injury, postoperative atrial fibrillation, postoperative low cardiac output, postoperative prolonged mechanical ventilation time, prolonged hospitalization time, unscheduled hospital readmission related to heart problems, and postoperative heart failure.