Is NT-proBNP a marker for adverse postoperative outcomes in patients undergoing lung and esophageal surgery?

We have read with great interest the article by Mitchell and Webb [1] and the eComment by Raja and Chowdhury [2] reporting on the validity of NT-proBNP as a marker for adverse postoperative outcomes in patients undergoing cardiac surgery. Elevation of perioperative NT-proBNP is a strong independent predictor of postoperative atrial fibrillation (AF) in patients undergoing thoracic surgery for lung cancer [3] as also demonstrated in patients undergoing surgery for esophageal carcinoma [4]. According to our experience and the findings of Mitchell and Webb, despite the conclusion of Raja and Chowdhury, we find an important and significant correlation between the elevation of perioperative NT-proBNP (>1000 pg/ml) and postoperative AF in esophageal and lung surgery. Finally, we do not agree with the conclusion of Raja and Chowdhury [2] that currently the only reasonable practical application of BNP and NT-proBNP as a marker is limited to the differentiation of acute dyspnea, monitoring of therapeutic responses, and prognosis of acute or decompensated congestive heart failure.