Pre- and Postoperative N-Terminal Pro B-Type Natriuretic Peptide Dynamics and Outcomes After Emergency Laparotomy.

Abstract

The prognostic value of N-terminal pro B-type natriuretic peptide has only been sparsely studied in patients undergoing emergency laparotomy, where acute systemic inflammation and physiological derangement may affect perioperative N-terminal pro B-type natriuretic peptide dynamics. Our objective was to assess the prognostic association of preoperative and postoperative N-terminal pro B-type natriuretic peptide concentrations in patients undergoing emergency laparotomy. We conducted an exploratory retrospective cohort study using prospectively registered data. The association between preoperative and postoperative N-terminal pro B-type natriuretic peptide concentrations and 90-day mortality was analysed using logistic regression after logarithmic transformation, with effect estimates expressed as odds ratios per doubling in biomarker concentration. Secondary exploratory analyses included internally derived threshold-based analyses and assessment of perioperative N-terminal pro B-type natriuretic peptide patterns. In total, we included 249 patients. Each doubling of preoperative and postoperative N-terminal pro B-type natriuretic peptide concentrations was associated with increased unadjusted odds of 90-day mortality (preoperative OR 1.89, 95% CI 1.49-2.40; postoperative OR 2.29, 95% CI 1.71-3.06). Secondary exploratory analyses using internally derived thresholds showed a similar directional pattern. Patients with elevated preoperative but lower postoperative N-terminal pro B-type natriuretic peptide concentrations displayed lower observed mortality compared to those with persistently elevated concentrations. Preoperative and postoperative N-terminal pro B-type natriuretic peptide concentrations were associated with 90-day mortality in patients undergoing emergency laparotomy. The prognostic relevance of N-terminal pro B-type natriuretic peptide trajectories warrants further study. This study examines perioperative NT-proBNP dynamics in emergency laparotomy patients, showing higher pre- and postoperative levels predict increased 90-day mortality. It suggests biomarker trajectories, not just absolute values, may refine risk stratification, as declining postoperative levels were associated with lower mortality than persistently elevated concentrations, highlighting potential clinical value while emphasising need for prospective validation.