Abstract
BackgroundHand-foot-mouth disease (HFMD) is an acute infectious disease caused by enteroviruses, and HFMD complicated by cardiopulmonary failure has a high mortality. B type natriuretic peptide (BNP) is widely applied in monitoring cardiovascular disorders, and thus, we investigated whether this index was associated with the severity of HFMD and the outcome in severe HFMD.MethodsSerum BNP, lactate, and glucose levels as well as white blood cell (WBC) count, PaO2/FiO2, and cardiac output (CO) were analyzed in the 83 enrolled HFMD patients according to different conditions (common, severe, and critical; with and without complication; and survivors and non-survivors). The control group consisted of 29 patients with respiratory tract infections.ResultsNo significant differences in CO were observed between the groups. Serum lactate, glucose, BNP, and WBC levels in the critical group were significantly higher than those in the severe, common, and control groups (p < 0.01 or 0.05). The PaO2/FiO2 ratio was significantly lower in the critical group (214.286 ± 154.346) than in the other groups. According to logistic regression analysis, the areas under the curve for serum BNP, glucose, and PaO2/FiO2 of the patients with complications were 0.774, 0.738, and 0.75, respectively. Moreover, the BNP level was significantly higher in HFMD patients with complications and non-survivors.ConclusionOur findings indicate that BNP could be a biochemical indicator for severe (critical) HFMD and used for prognosis in terms of complications and death. Combined with Glu and PaO2/FiO2 and clinical symptoms of HFMD, the value of BNP as an indicator became more precise and specific. Our results may provide another valuable, objective biochemical indicator for severe HFMD.Trial registration numberChiCTR-DDT-14004576. Name of registry: Chinese Clinical Trial Registry. Date of registration: 2014–09-21.
Highlights
Hand-foot-mouth disease (HFMD) is an acute infectious disease caused by enteroviruses, and HFMD complicated by cardiopulmonary failure has a high mortality
To test our hypothesis in the present study, we analyzed the data of 83 HFMD patients with or without severe complications treated in our hospital from April 2014 to March 2015 according to the severity of HFMD
These results indicated that a serum B type natriuretic peptide (BNP) concentration of 70 pmol/L could be an indicator of critical HFMD
Summary
Hand-foot-mouth disease (HFMD) is an acute infectious disease caused by enteroviruses, and HFMD complicated by cardiopulmonary failure has a high mortality. Hand-foot-mouth disease (HFMD) is an acute infectious disease caused by various enteroviruses, and the most common pathogens are Coxsackievirus A16 (CA16) and Enterovirus 71 (EV71). In severe cases of HFMD, varying degrees of neurological complications (such as encephalitis and neurogenic pulmonary edema) and circulatory complications can occur. This severe form of HFMD has a high mortality rate, and survivors often suffer from long-term sequelae [1, 2]. Most cases of death occur in patients who reach Phases III and IV, and these two phases represent the crucial period for treating severe HFMD. Because cardiopulmonary failure is the major cause of death among HFMD patients [6], the primary goal in treating severe HFMD is to maintain the stability of cardiopulmonary circulation function
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