Natriuretic peptides for the prediction of severely impaired peak VO2 in patients with lung disease

SummaryBackgroundB-type natriuretic peptide (BNP) is a predictor of death in patients with lung disease. We hypothesised that in patients with lung disease, BNP and N-terminal-pro-B-type natriuretic peptide (NT-proBNP) could predict a peak VO2 < 15 ml/kg/min, which is the proposed cut-off indicating an increased risk of perioperative complications during lung resection surgery.MethodsBNP and NT-proBNP were measured in 85 patients with a variety of pulmonary pathologies undergoing cardiopulmonary exercise testing and fulfilling criteria for appropriate effort.ResultsBNP [69 (42–270) vs. 33 (15–65) pg/ml; p = 0.001] and NT-proBNP [290 (129–1075) vs. 65 (21–129) pg/ml; p < 0.001] were higher in patients with peak VO2 < 15 ml/kg/min (n = 27) as compared to those with peak VO2 ≥ 15 ml/kg/min (n = 58). Apart from the forced expiratory volume within the first second (FEV1), body mass index (BMI), diabetes, and the alveolo-arterial oxygen pressure difference [D(A-a)O2; only in the BNP model], BNP or NT-proBNP respectively were independent predictors of peak VO2 < 15 ml/kg/min. The areas under the receiver-operator-characteristics curve (AUC) for BNP and NT-proBNP to predict a peak VO2 < 15 ml/kg/min were 0.73 and 0.80 respectively. A five-item (BNP) or four-item (NT-proBNP) score including BMI, FEV1, diabetes, D(A-a)O2, and BNP/NT-proBNP had an AUC of 0.87 and 0.88 respectively for the prediction of peak VO2 < 15 ml/kg/min.ConclusionsIn patients with lung disease, BNP or NT-proBNP is independently associated with low peak VO2. A simple score based on spirometry, blood gases and BNP or NT-proBNP has a high accuracy for the prediction of a peak VO2 < 15 ml/kg/min.