Admission N-terminal pro-brain natriuretic peptide (NT-proBNP) level predicts the development of atrial fibrillation in general surgical intensive care unit patients.

Background: New onset atrial fibrillation (AF) in critically ill surgical patients is associated with significant morbidity and increased mortality. N-terminal pro-B type natriuretic peptide (NT-proBNP) is released by cardiomyocytes in response to stress and may predict AF development after surgery. We hypothesized that elevated NT-proBNP level at surgical ICU admission predicts AF development in a general surgical and trauma population. Methods: From July to October 2015, NT-proBNP concentrations were measured at ICU admission. Abnormal NT-proBNP concentrations were defined by age-adjusted cut-offs. We examined the relationship between the development of AF and demographics, clinical variables, and NT-proBNP level using univariate analysis and a multivariable logistic regression model. Results: 387 subjects were included in the cohort, none of whom were in AF at ICU admission. The median age was 63 [52-73] years and 40.3% were female. The risk of developing AF was higher for abnormal vs. normal NT-proBNP (22% vs. 4% p=2,000 ng/L. Multiple logistic regression analysis identified three independent predictors for new-onset AF: Age >= 70 (OR 3.7, 95% CI 1.5-9.3), history of AF (OR 25.3, 95% CI 9.6-67.0), and NT-proBNP >= 600 (OR 4.3, 95% CI 1.3-14.2). When none or only one predictor was present, AF incidence was = 70 but no history of atrial fibrillation, AF incidence was 12.8% when NT-proBNP was >=600 compared to 0% when NT-proBNP was =600 compared to 0% when NT-proBNP was

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