title: B-type natriuretic peptide-guided risk assessment for postoperative complications in lung cancer surgery.
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.
authors.affiliation: Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 (L5) Yamadaoka, Suita, Osaka, 565-0871, Japan, nojirit@thoracic.med.osaka-u.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nojiri
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Inoue
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shintani
authors.forename: Yukiyasu
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Hajime
authors.initials: H
authors.lastname: Maeda
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Hamasaki
authors.forename: Meinoshin
authors.initials: M
authors.lastname: Okumura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001281:Atrial Fibrillation / Q000097:blood / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011014:Pneumonia / Q000097:blood / Q000209:etiology; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012372:ROC Curve; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D013908:Thoracotomy / Q000009:adverse effects; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain