Introduction: Increased N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration predicts poor prognosis of non-CNS cancer patients. We evaluated the association of NT-proBNP concentration with disease severity, discharge outcomes and prognosis of patients undergoing elective craniotomy for brain tumor.
Methods: From January, 2010 until September, 2011 two-hundred and forty-five patients (mean age 55.05±14.62 years) admitted for brain tumor surgery were evaluated for NT-proBNP serum concentration. Outcome at hospital discharge was evaluated with the Glasgow Outcome Scale (GOS). Ninety-four patients were also evaluated for cognitive functioning (Mini Mental State Examination or MMSE), functional status (Barthel Index or BI) and depressive symptom severity (Hospital Anxiety and Depression scale or HADS). Follow-up continued until November, 2015.
Results: The majority of patients were diagnosed with meningioma (37%) and high-grade glioma (20%). NT-proBNP concentrations was elevated in 80 (33%) patients. Greater NT-proBNP concentration was associated with lower BI (rho = -0.305) and MMSE scores (rho = -0.314) and with greater HADS-Depression score (rho = 0.240). NT-proBNP concentrations above the reference range (=157 ng/l) was associated with greater odds for unfavorable outcome at hospital discharge (GOS score =3) adjusting for age, gender and histological diagnosis (HR = 2.268 95%CI [1.04-3.493], p=0.039). NT-proBNP concentration above the median value (=93.15 ng/L) was associated with greater 90-day (HR = 4.416, 95%CI [1.157 – 16.851], p=0.03) and 5-year (HR = 1.687; 95%CI [1.038-2.743], p=0.035) mortality risk controlling for age, gender, histological diagnosis and adjuvant therapy.
Conclusions: Greater pre-operative NT-proBNP concentration is associated with worse health status, unfavorable outcome at hospital discharge and greater mortality risk of brain tumor patients.
Patient Care: The research will help to more accurately prognosticate neurosurgical brain tumor patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of preoperative N-terminal pro-B-type natriuretic peptide assessment in brain tumor patients, 2) Discuss prognostic value of N-terminal pro-B-type natriuretic peptide in neurosurgical patients, 3) Better prognosticate peri-operative outcomes and prognosis of brain tumor patients.