Int J Med Sci 2021; 18(12):2500-2509. doi:10.7150/ijms.54202 This issue

Research Paper

Combined B-type Natriuretic Peptide as strong predictor of short-term mortality in patients after Liver Transplantation

Hyun Sik Chung1, AMi Woo1, Min Suk Chae2, Sang Hyun Hong2, Chul Soo Park2, Jong Ho Choi2, Yun Sung Jo3✉

1. Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
2. Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
3. Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi, Republic of Korea.

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Citation:
Chung HS, Woo A, Chae MS, Hong SH, Park CS, Choi JH, Jo YS. Combined B-type Natriuretic Peptide as strong predictor of short-term mortality in patients after Liver Transplantation. Int J Med Sci 2021; 18(12):2500-2509. doi:10.7150/ijms.54202. Available from https://www.medsci.org/v18p2500.htm

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Abstract

Graphic abstract

Background: B-type natriuretic peptide (BNP) is a well-known predictor for prognosis in patients with cardiac and renal diseases. However, there is a lack of studies in patients with advanced hepatic disease, especially patients who underwent liver transplantation (LT). We evaluated whether BNP could predict the prognosis of patients who underwent LT.

Material and Methods: The data from a total of 187 patients who underwent LT were collected retrospectively. The serum levels of BNP were acquired at four time points, the pre-anhepatic (T1), anhepatic (T2), and neohepatic phases (T3), and on postoperative day 1 (T4). The patients were dichotomized into survival and non-survival groups for 1-month mortality after LT. Combined BNP (cBNP) was calculated based on conditional logistic regression analysis of pairwise serum BNP measurements at two time points, T2 and T4. The area under the receiver operating characteristic curve (AUROC) was analyzed to determine the diagnostic accuracy and cut-off value of the predictive models, including cBNP.

Results: Fourteen patients (7.5 %) expired within one month after LT. The leading cause of death was sepsis (N = 9, 64.3 %). The MELD and MELD-Na scores had an acceptable predictive ability for 1-month mortality (AUROC = 0.714, and 0.690, respectively). The BNPs at each time point (T1 - T4) showed excellent predictive ability (AUROC = 0.864, 0.962, 0.913, and 0.963, respectively). The cBNP value had an outstanding predictive ability for 1-month mortality after LT (AUROC = 0.976). The optimal cutoff values for cBNP at T2 and T4 were 137 and 187, respectively.

Conclusions: The cBNP model showed the improved predictive ability for mortality within 1-month of LT. It could help clinicians stratify mortality risk and be a useful biomarker in patients undergoing LT.

Keywords: B-type natriuretic peptide, liver transplantation, mortality, prognosis, sensitivity, specificity