B-type natriuretic peptide predicts deterioration in functional capacity following lung resection

Young, D. J., McCall, P. J. , Kirk, A., MacFie, A., Kinsella, J. and Shelley, B. G. (2019) B-type natriuretic peptide predicts deterioration in functional capacity following lung resection. Interactive Cardiovascular and Thoracic Surgery, 28(6), pp. 945-952. (doi: 10.1093/icvts/ivz016) (PMID:30753496)

Abstract

OBJECTIVES Following lung resection, there is a decrease in the functional capacity and quality of life, which is not fully explained by changes in pulmonary function. Previous work demonstrates that B-type natriuretic peptide (BNP) is associated with short- and long-term complications following lung resection, leading to the suggestion that cardiac dysfunction may contribute to functional deterioration. Our aim was to investigate any relationship between BNP and subjective and objective indices of functional deterioration following lung resection surgery. METHODS Twenty-seven patients undergoing lung resection had serum BNP measured preoperatively, on postoperative day (POD)1 and POD2, and at 2 months postoperatively. The functional deterioration was assessed using 6-min walk tests and the Medical Research Council dyspnoea scale. ‘Deterioration in functional capacity’ was defined as either an increase in the Medical Research Council dyspnoea score or a significant decrease in the 6-min walk test distance. RESULTS BNP increased over time (P < 0.01) and was significantly elevated on POD1 and POD2 (P < 0.02 for both). Seventeen patients demonstrated functional deterioration 2 months postoperatively. At all perioperative time points, BNP was significantly higher in patients showing deterioration (P < 0.05 for all). Preoperative BNP was predictive of functional deterioration at 2 months with an area under the receiver-operating characteristic curve of 0.82 (P = 0.01, 95% confidence interval 0.65–0.99). CONCLUSIONS This study has demonstrated, using subjective and objective measures, that preoperative BNP is a predictor of functional deterioration following lung resection. BNP may have a role in preoperative risk stratification in this population, allowing therapy in future to be targeted towards high-risk patients with the aim of preventing postoperative cardiac dysfunction. Clinical trial registration number: NCT01892800.

• Item Type: Articles
• Additional Information: Funding for this project was provided by the Association for Cardiothoracic Anaesthesia and Critical Care Project Grant 2012
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Kirk, Mr Alan and Shelley, Dr Benjamin and MacFie, Dr Alistair and McCall, Dr Philip and Kinsella, Professor John
• Authors: Young, D. J., McCall, P. J., Kirk, A., MacFie, A., Kinsella, J., and Shelley, B. G.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Interactive Cardiovascular and Thoracic Surgery
• Publisher: Oxford University Press
• ISSN: 1569-9293
• ISSN (Online): 1569-9285
• Published Online: 08 February 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Interactive Cardiovascular and Thoracic Surgery 28(6):945-952
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher