Skip to main content
SpringerLink
Log in

B-Type Natriuretic Peptide-Guided Risk Assessment for Postoperative Complications in Lung Cancer Surgery

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Since lung cancer surgery is still associated with a high complication rate, it is important to efficiently identify patients at high risk for postoperative complications following lung cancer surgery. We previously reported that elderly patients with elevated preoperative B-type natriuretic peptide (BNP) levels (>30 pg/mL) have an increased risk for postoperative atrial fibrillation and cardiopulmonary complications following lung cancer surgery. The objective of this study was to evaluate the clinical utility of BNP-guided risk classification for postoperative complications after lung cancer surgery.

Methods

A total of 675 consecutive patients who underwent curative surgery for lung cancer in two specialized thoracic centers between 2007 and 2011 were included in this retrospective study. We evaluated the association between the incidence of postoperative complications and preoperative BNP levels.

Results

Univariable and multivariable stepwise logistic regression analyses revealed that an elevated preoperative BNP level was the most significant predictor of postoperative complications. All patients were classified by their preoperative BNP levels into a normal group (<30 pg/mL), a mildly elevated group (30–100 pg/mL), and a severely elevated group (>100 pg/mL). The incidence of postoperative complications was significantly higher in the severely and mildly elevated groups than in the control group (85 % and 47 % vs. 11 %, P < 0.0001). Furthermore, there were more severe complications and a higher mortality rate in the severely elevated group.

Conclusions

Risk assessment using preoperative BNP levels was clinically useful for the identification of patients at high risk for postoperative complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Allen MS, Darling GE, Pechet TT et al (2006) Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 81:1013–1019

    Article  PubMed  Google Scholar 

  2. Boffa DJ, Allen MS, Grab JD et al (2008) Data from the society of thoracic surgeons general thoracic surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg 135:247–254

    Article  PubMed  Google Scholar 

  3. McMurray JJ, Adamopoulos S, Anker SD et al (2012) ESC Committee for Practice Guidelines. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33:1787–1847

    Article  PubMed  Google Scholar 

  4. Maisel AS, Krishnaswamy P, Nowak RM et al (2002) Breathing not properly multinational study investigators. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 347:161–167

    Article  CAS  PubMed  Google Scholar 

  5. Suzuki M, Hamada M, Yamamoto K et al (2002) Brain natriuretic peptide as a risk marker for incident hypertensive cardiovascular events. Hypertens Res 25:669–676

    Article  CAS  PubMed  Google Scholar 

  6. Inoue Y, Kawayama T, Iwanaga T et al (2009) High plasma brain natriuretic peptide levels in stable COPD without pulmonary hypertension or cor pulmonale. Intern Med 48:503–512

    Article  PubMed  Google Scholar 

  7. Birim O, Kappetein AP, Waleboer M et al (2006) Long-term survival after non-small cell lung cancer surgery: development and validation of a prognostic model with a preoperative and postoperative mode. J Thorac Cardiovasc Surg 132:491–498

    Article  PubMed  Google Scholar 

  8. Win T, Jackson A, Sharples L et al (2005) Relationship between pulmonary function and lung cancer surgical outcome. Eur Respir J 25:594–599

    Article  CAS  PubMed  Google Scholar 

  9. Nojiri T, Maeda H, Takeuchi Y et al (2010) Predictive value of B-type natriuretic peptide for postoperative atrial fibrillation following pulmonary resection for lung cancer. Eur J Cardiothorac Surg 37:787–791

    Article  PubMed  Google Scholar 

  10. Nojiri T, Inoue M, Yamamoto K et al (2011) B-type natriuretic Peptide as a predictor of postoperative cardiopulmonary complications in elderly patients undergoing pulmonary resection for lung cancer. Ann Thorac Surg 92:1051–1055

    Article  PubMed  Google Scholar 

  11. Amar D, Zhang H, Shi W et al (2012) Brain natriuretic peptide and risk of atrial fibrillation after thoracic surgery. J Thorac Cardiovasc Surg 144:1249–1253

    Article  CAS  PubMed  Google Scholar 

  12. Nojiri T, Inoue M, Yamamoto K et al (2012) Effects of low-dose human atrial natriuretic peptide for preventing post-operative cardiopulmonary complications in elderly patients undergoing pulmonary resection for lung cancer. Eur J Cardiothorac Surg 41:1330–1334

    Article  PubMed  Google Scholar 

  13. Nojiri T, Inoue M, Maeda H et al (2013) Low-dose human atrial natriuretic peptide for the prevention of postoperative cardiopulmonary complications in chronic obstructive pulmonary disease patients undergoing lung cancer surgery. Eur J Cardiothorac Surg 44:98–103

    Article  PubMed  Google Scholar 

  14. Bellomo R, Ronco C, Kellum JA et al (2004) Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212

    Article  PubMed Central  PubMed  Google Scholar 

  15. Ryding AD, Kumar S, Worthington AM et al (2009) Prognostic value of brain natriuretic peptide in noncardiac surgery: a meta-analysis. Anesthesiology 111:311–319

    Article  CAS  PubMed  Google Scholar 

  16. Nagaya N, Nishikimi T, Okano Y et al (1998) Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension. J Am Coll Cardiol 31:202–208

    Article  CAS  PubMed  Google Scholar 

  17. Buch P, Friberg J, Scharling H et al (2003) Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study. Eur Respir J 21:1012–1016

    Article  CAS  PubMed  Google Scholar 

  18. Barr RG, Bluemke DA, Ahmed FS et al (2010) Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med 362:217–227

    Article  PubMed Central  PubMed  Google Scholar 

  19. Tsang TS, Gersh BJ, Appleton CP et al (2002) Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol 40:1636–1644

    Article  PubMed  Google Scholar 

  20. Abusaid GH, Barbagelata A, Tuero E et al (2009) Diastolic dysfunction and COPD exacerbation. Postgrad Med 121:76–81

    Article  PubMed  Google Scholar 

  21. Lubien E, DeMaria A, Krishnaswamy P et al (2002) Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings. Circulation 105:595–601

    Article  CAS  PubMed  Google Scholar 

  22. Nojiri T, Maeda H, Takeuchi Y et al (2010) Predictive value of preoperative tissue Doppler echocardiographic analysis for postoperative atrial fibrillation after pulmonary resection for lung cancer. J Thorac Cardiovasc Surg 140:764–768

    Article  PubMed  Google Scholar 

  23. Wiley CL, Switzer SP, Berg RL et al (2010) Association of B-type natriuretic Peptide levels with estimated glomerular filtration rate and congestive heart failure. Clin Med Res 8:7–12

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Jourdain P, Jondeau G, Funck F et al (2007) Plasma brain natriuretic peptide-guided therapy to improve outcome in heart failure: the STARS-BNP multicenter study. J Am Coll Cardiol 49:1733–1739

    Article  CAS  PubMed  Google Scholar 

  25. Savarese G, Trimarco B, Dellegrottaglie S et al (2013) Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials. PLoS One 8:e58287

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 (L5) Yamadaoka, Suita, Osaka, 565-0871, Japan

    Takashi Nojiri, Masayoshi Inoue, Yasushi Shintani & Meinoshin Okumura

  2. Department of Biochemistry, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan

    Takashi Nojiri

  3. Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Toyonaka, Osaka, Japan

    Yukiyasu Takeuchi & Hajime Maeda

  4. Innovative Clinical Trials and Data Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Toshimitsu Hamasaki

Authors
  1. Takashi Nojiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masayoshi Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasushi Shintani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yukiyasu Takeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hajime Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Toshimitsu Hamasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Meinoshin Okumura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takashi Nojiri.

Additional information

Trial Registration Number: JPRN-UMIN3631

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nojiri, T., Inoue, M., Shintani, Y. et al. B-Type Natriuretic Peptide-Guided Risk Assessment for Postoperative Complications in Lung Cancer Surgery. World J Surg 39, 1092–1098 (2015). https://doi.org/10.1007/s00268-015-2943-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-015-2943-6

Keywords

Search

Navigation