Perioperative NT-proBNP Risk Triage Model (VISION-based)

Perioperative NT-proBNP Risk Triage Model: Comprehensive Explanation and Clinical Context N-terminal pro–B-type natriuretic peptide (NT-proBNP) is a cardiac biomarker that reflects myocardial wall stress and neurohormonal activation. In large perioperative cohorts, preoperative NT-proBNP provides substantial prognostic information for vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days, complementing and often outperforming traditional clinical risk indices. Original publication–based categories (VISION): Patients are triaged into four strata using preoperative NT-proBNP measured within 30 days before surgery: <100 pg/mL (Low), 100–199 pg/mL (Elevated), 200–1499 pg/mL (High), and ≥1500 pg/mL (Very High).

These strata correspond to progressively higher incidences of the composite outcome (vascular death or MINS) at 30 days and higher all-cause mortality. This calculator implements those exact thresholds and published incidence estimates to provide a pragmatic, evidence-based risk estimate. Clinical significance: Compared with patients <100 pg/mL, those with 100–<200, 200–<1500, and ≥1500 pg/mL have markedly higher adjusted hazards for vascular events.

Incorporating NT-proBNP into perioperative assessment can improve risk stratification, guide shared decision-making, and inform intensity of monitoring (e.g., consideration of perioperative troponin surveillance, hemodynamic vigilance, and postoperative telemetry in high/very-high strata). Clinical interpretation summary: Low (<100 pg/mL) suggests low biomarker-defined risk. Elevated (100–199 pg/mL) indicates nontrivial risk; ensure optimization of comorbidities and appropriate monitoring.

High (200–1499 pg/mL) and Very High (≥1500 pg/mL) indicate substantial risk of perioperative vascular events; consider escalated perioperative optimization and postoperative troponin monitoring as aligned with institutional protocols. Always interpret alongside clinical context (surgical magnitude, urgency, comorbidities, and institutional pathways).