Abstract
This clinical study investigated plasma NT-proBNP levels as a potential predictor of heart failure in pediatric patients with sepsis. Plasma NT-ProBNP levels of 211 pediatric patients with sepsis and 126 healthy children were measured. Patients were stratified as with heart failure (HF) or without heart failure (non-HF). Patients were graded as having sepsis, severe sepsis, or septic shock. The optimal cut-off values of plasma NT-ProBNP for heart failure were determined by analyzing the receiver operating characteristic (ROC). In the HF, non-HF and control groups, the median plasma NT-proBNP levels were 3640, 656, and 226 ng/L, respectively. For all patients with sepsis, the optimal diagnostic cut-off value was 1268 ng/L for differentiating heart failure. In the severe sepsis patients and septic shock patients, the optimal diagnostic cut-off values were 1368 ng/L and 1525 ng/L, respectively. This report is the first one to reveal that NT-proBNP may predict heart failure in children with sepsis. It provides an important clinical reference for the diagnosis of heart failure in pediatric patients with sepsis, and enables monitoring septic children for cardiac involvement.
Highlights
Plasma NT-proBNP levels are often used as a biological marker of heart failure [1,2,3,4,5,6,7,8]
This study investigated whether plasma NT-proBNP levels can be used to predict heart failure in pediatric patients with sepsis
This study found that NT-proBNP levels in sepsis patients were significantly higher than that of non-sepsis patients, suggesting the need to determine the appropriate diagnostic cut-off points for heart failure in septic patients that will be conducive to the management of septic patients with heart failure
Summary
Plasma NT-proBNP levels are often used as a biological marker of heart failure [1,2,3,4,5,6,7,8]. Heart failure may be diagnosed in adults younger than 50 years when NT-proBNP levels are >450 ng/L [9], and in children up to 14 years if !500 ng/L [10]. The association between sepsis and cardiac dysfunction is well established [15], the response of plasma NT-proBNP to a septic condition has not been clearly demonstrated. Patients with sepsis often have cardiovascular or other organ dysfunction, but a specific correlation between heart failure and NT-ProBNP in these patients is not clear. When sepsis is present it is difficult to determine the relevancy of NT-proBNP for diagnosing heart failure
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