Elsevier

Clinical Lung Cancer

Volume 11, Issue 5, September 2010, Pages 341-345
Clinical Lung Cancer

Original Study
High N-Terminal Pro–B-Type Natriuretic Peptide: A Biomarker of Lung Cancer?

https://doi.org/10.3816/CLC.2010.n.043Get rights and content

Abstract

Background

The level of N-terminal pro–B-type natriuretic peptide (NT-proBNP) is affected by many known factors. Our study aimed to evaluate whether other factors, in particular lung cancer, could be responsible for an increase in NT-proBNP levels in a population with no known risk factors for elevated NT-proBNP.

Patients and Methods

This study was based on the RIABO (Recueil de l’Ischémie au Bloc Opératoire) database, a single-center registry that prospectively records in elective noncardiac surgery. Patients aged > 75 years and those presenting with 1 or more known risk factors for high NT-proBNP were excluded. Patients were divided into 2 groups according to preoperative NT-proBNP levels: (≥ 125 pg/mL or < 125 pg/mL).

Results

Between October 2005 and February 2007, 439 patients were eligible for inclusion. Among 35 patients with lung cancer, 26 (74%) had elevated NT-proBNP (≥ 125 pg/mL), versus 9 (26%) with NT-proBNP < 125 pg/mL (P < .0001). By multivariate analysis, the presence of lung cancer was an independent risk factor for a level of NT-proBNP ≥ 125 pg/mL (odds ratio, 7; 95% CI, 2.9-17; P < .0001). We also observed an independent relationship between NT-proBNP ≥ 125 pg/mL and age, female sex, smoking status, and C-reactive protein levels.

Conclusion

In our study, patients with lung cancer were 7 times more likely to have elevated NT-proBNP (≥ 125 pg/mL). The presence of lung cancer should therefore be taken into account when interpreting NT-proBNP levels. Further studies are warranted to explore the diagnostic value of this marker in lung cancer and to identify the cause of the elevation.

Introduction

N-terminal pro–B-type natriuretic peptide (NT-proBNP) is secreted by cardiomyocytes in response to volume overload or excessive pressure that increases tension in the left ventricle.1 It is first secreted in the form of pre-proBNP, which then splits into the active peptide, BNP,2, 3 and the biologically inactive N-terminal fragment, NT-proBNP.1, 4 NT-proBNP is used in cardiology, respiratory, medicine and emergency care, particularly to determine a possible cardiologic etiology of acute dyspnea.5, 6, 7, 8, 9 Indeed, several studies have demonstrated that the evaluation of NT-proBNP before anesthesia is useful, and that it can predict postoperative complications in the short and medium term, and mortality at 1 year. However, the interpretation of elevated NT-proBNP levels remains difficult because of several confounding factors such as acute and chronic heart failure,10, 11 coronary disease,12, 13, 14, 15 advanced age,10 renal insufficiency,16 respiratory diseases such as pulmonary hypertension, leading to right ventricular dysfunction, thromboembolic disease, atrial fibrillation,17 cirrhosis, sepsis,18, 19 or dysthyroid could be responsible.1, 9 Conversely, obesity can be responsible for a reduction in NT-proBNP levels.20

Indeed, we have noted in our own experience that some patients, particularly those with lung cancer, can present with elevated NT-proBNP levels despite the absence of any known risk factor.

In this context, the main purpose of our study was to determine whether other factors, in particular lung cancer, could be responsible for an increase in preoperative NT-proBNP levels in a population of patients with no known risk factors for elevated NT-proBNP and undergoing elective noncardiac surgery.

Section snippets

Patients and Methods

The patient population of this study was part of a wider database that RIABO (Recueil de l’Ischémie au Bloc Opératoire) designed to evaluate predictors of postoperative myocardial injury. The RIABO database includes all patients over 40 years of age undergoing elective noncardiac surgery (principally thoracic, digestive, vascular, and orthopedic surgery). Between October 2005 and February 2007, a total of 2062 patients were prospectively included. For each patient, 215 items relating to

Results

In total, 439 patients were eligible for inclusion in this analysis (Figure 1). Mean age was 58 ± 8.57 years; 293 (67%) were men. Overall, 115 patients presented with cancer, of whom 35 (30%) had lung cancer. In total, 341 patients presented with NT-proBNP < 125 pg/mL, and 98 with NT-proBNP ≥ 125 pg/mL (Table 1). The different types of surgery were 30% digestive surgery; 20% thoracic, orthopedic, and vascular surgery; and 10% urologic surgery.

The results of the univariate analysis are presented

Discussion

To the best of our knowledge, our study is one of very few reports to examine possible predictors of elevated NT-proBNP levels in a population of patients with no known risk factors likely to modify NT-proBNP levels. Indeed, our exclusion criteria covered all factors reported in the literature likely to cause high levels of NT-proBNP,1, 9 namely acute and chronic heart failure10, 11; coronary disease12, 13, 14, 15; advanced age10; renal insufficiency16; respiratory diseases such as pulmonary

Conclusion

NT-proBNP is a cardiac biomarker that is increasingly used in clinical practice. In our study, we observed a strong relationship between the presence of lung cancer and elevated levels of NT-proBNP. In our study, patients with lung cancer were 7 times more likely to have a high level of NT-proBNP. Therefore, the presence of lung cancer should be taken into account in the differential diagnosis when interpreting elevated NT-proBNP levels. Further studies are warranted to evaluate the diagnostic

Disclosures

The authors have no relevant relationships to disclose.

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