Abstract
Brain natriuretic peptide (pg/ml) is a cardioprotective hormone released in response to pressure or volume overload of the heart. High preoperative brain natriuretic peptide levels in persons with dysvascular major lower limb amputation may indicate cardiac stress threatening survival. The aim of this retrospective database study was to analyze the association between brain natriuretic peptide, heart failure and survival in persons with dysvascular major lower limb amputation.
Data of persons with dysvascular major lower limb amputations, at Nij Smellinghe Hospital (2010 to 2018), were included. Brain natriuretic peptide levels, determined pre- and/or post-amputation, were collected. Persons were categorized in two groups: ‘low’ brain natriuretic peptide (≤91 pg/ml) and ‘high’ brain natriuretic peptide (>91 pg/ml).
Data of 59 persons (median ge 73, interquartile range 66;80, 42 males) were included. Survivors had a significantly lower preoperative brain natriuretic peptide level (median 46, interquartile range 21;75) compared to non-survivors (median 135, interquartile range 38;316, Mann-Whitney U Test: p=0.029) and postoperative brain natriuretic peptide levels (median 26, interquartile range 16;42) compared to non-survivors (median 176, interquartile range 61;323, p=0.007). The ‘low’ brain natriuretic peptide group lived significantly longer (median 2305 days, interquartile range 1361;2979) than the ‘high’ brain natriuretic peptide group (median 687 days, interquartile range 87;1224, Log Rank=20.843; Kaplan-Meier: p=<0.001). Persons with high brain natriuretic peptide and heart failure lived shorter than those with low brain natriuretic peptide and heart failure (Kruskal-Wallis Test: p=0.008) and those with low brain natriuretic peptide without heart failure (p=0.004). Survival was shortest in the group with the high brain natriuretic peptide levels and heart failure.
In this small study, brain natriuretic peptide levels, also combined with heart failure, were associated with survival in persons with a major lower limb amputation.