BNP for prediction of outcome following lung resection surgery (Profiles); an interim analysis

Abstract

Introduction Lung cancer is the leading cause of cancer death in the UK with the highest incidence in Scotland. In suitable cases surgical resection is the first-choice treatment; resection rates have risen markedly particularly in elderly patients. Lung cancer surgery is associated with significant co-morbidity resulting in high cardio-respiratory complication rates. B-type natriuretic peptide (BNP) is a quantitative biomarker of myocardial dysfunction, identifying patients at risk of cardiopulmonary complications in a variety of surgeries. Little work has focused on its use for prediction of cardiopulmonary complications following lung resection. The British Thoracic Society (BTS) and The National Institute of Clinical Excellence (NICE) highlight the need for studies concerning patient fitness and operative risk when deciding to undergo lung resection. This analysis explores the predictive role of BNP as a peri-operative biomarker of cardiopulmonary complications following lung resection. Methods With informed consent and ethics approval we prospectively recruited 107 patients undergoing lung resection in a single centre. BNP was measured pre-op (BNPpre-op) and on post-op days 2&3 (BNPpost-op). Association was sought between peri-operative BNP levels and cardiopulmonary complications (according to the European Society of Thoracic Surgeons definitions) and hospital length of stay. Friedman's test, Mann-Whitney U-test and Spearman's rank test were used as appropriate. Results BNP increased post-operatively, peaking on POD2, (p Discussion This study demonstrates association between peri-operative BNP levels and post-operative, in-hospital, cardio-pulmonary complications highlighting the potential for BNP as a predictive marker in patients undergoing lung resection. Further work is required to identify association between peri-operative BNP and longer-term complications and to explore the integration of BNP into risk prediction models for patients undergoing lung resection surgery. In previous pilot work, Pre-op BNP was associated with breathlessness 3-months postoperatively1. PROFILES is a multicentre prospective observational cohort study of 250 patients (across four sites in Scotland and Northern Ireland) undergoing lung resection and seeks to validate this finding (NCT03888937). Upon completion of recruitment we hope to create a novel scoring tool incorporating BNP, to identify those at risk of disabling dyspnoea.