Association between preoperative NT-proBNP levels and mortality among patients undergoing acute high-risk abdominal surgery: a prospective cohort study

Purpose: This study aims to evaluate the predictive value of the preoperative N-terminal pro b-type natriuretic peptide (NT-proBNP) level in patients undergoing acute high-risk abdominal (AHA) surgery, specifically investigating its association with postoperative mortality, cardiovascular complications, and major morbidity to determine its utility in guiding individualized perioperative management. Methods: Prospective single-center cohort study on patients undergoing AHA surgery at Copenhagen University Hospital – North Zealand, Denmark between March 1, 2021 and May 15, 2023 were included. Preoperative NT-proBNP levels were correlated with postoperative outcomes, including 30-day mortality, major adverse cardiovascular events (MACE), and overall postoperative complications. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to assess the predictive power of NT-proBNP. Results: A total of 127 patients were included. The 30-day mortality was 7.1%, and the incidence of MACE was 18.9%. For 30-day mortality, NT-proBNP showed a higher discriminative ability (AUC 0.84) than the Surgical Apgar Score (AUC 0.81), although this difference was not statistically significant (p = 0.68). The combined model, including both NT-proBNP and the Surgical Apgar Score, demonstrated superior performance compared with each predictor (AUC 0.92, 95% CI 0.85–1.00) and significantly outperformed the Surgical Apgar Score alone (p = 0.04). Risk stratification analyses using a 5% 30-day mortality risk showed that both the combined and NT-proBNP had a strong capacity for event exclusion with NPVs ≈ 95% for both mortality and MACE. Conclusions: The integration of preoperative measurement of NT-proBNP, particularly when combined with Surgical Apgar score, significantly improves the stratification of patients undergoing AHA surgery and guides perioperative management. ClinicalTrials.gov (NCT05992961).