Abstract
BackgroundSevere hand, foot, and mouth disease (HFMD) is sometimes associated with serious complications such as acute heart failure that can cause substantial child mortality. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a sensitive and specific biomarker of congestive heart failure. The aim of this study was to use plasma NT-proBNP levels to establish the severity of childhood HFMD.MethodsA retrospective study was performed in 128 Chinese patients with severe HFMD and 88 patients with mild HFMD treated between January 2014 and October 2015. Univariate and multiple logistic regression analyses were used to analyze the risk factors for severe HFMD. NT-proBNP levels were analyzed in 128 severe HFMD patients, and the predictive value of NT-proBNP was assessed by receiver operating characteristic analyses.ResultsMultivariate analysis controlling for several potential confounders showed that enterovirus 71 infection [odds ratio (OR) 19.944, 95 % confidence interval (CI) 6.492–61.271], peripheral WBC count (OR 3.428, 95 % CI 1.186–9.914), fasting glucose (OR 19.428, 95 % CI 2.236–168.784), procalcitonin (OR 9.084, 95 % CI 3.462–23.837, and NT-proBNP (>125 pg/mL) (OR 16.649, 95 % CI 4.731–58.585) were each associated with the severity of HFMD. The 45 dead severe patients had higher pre-procedural levels of NT-proBNP than the 83 cured severe patients (12776 ± 13115 versus 1435 ± 4201 pg/mL, P < 0.001). An NT-proBNP cutoff value of 982 pg/mL predicted mortality with 87 % sensitivity and 86 % specificity.ConclusionPlasma NT-pro-BNP level appears to be a useful biological marker for predicting the severity and mortality of HFMD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1929-9) contains supplementary material, which is available to authorized users.
Highlights
Severe hand, foot, and mouth disease (HFMD) is sometimes associated with serious complications such as acute heart failure that can cause substantial child mortality
Severe hand, foot and mouth disease (HFMD) associated with enterovirus (EV) 71 in children can result in high morbidity and mortality [1,2,3]
Pan-enterovirus real-time RT-PCR was performed to confirm the cases caused by Enterovirus 71 (EV71) infection
Summary
Foot, and mouth disease (HFMD) is sometimes associated with serious complications such as acute heart failure that can cause substantial child mortality. Since 2008, nationwide epidemics of EV71 have occurred [8,9,10] in China, affecting 4.5 million children, and >3500 have died from the disease due to neurogenic cardiopulmonary failure and brainstem encephalitis, according to the Chinese Center for Disease Control and Prevention (http://www.chinacdc.cn/). These outbreaks of HFMD and high mortality represent a significant public health problem in China. Feasible prognosis prediction of severe HFMD would aid clinical decisions and management
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