Relationship between serum levels of growth differentiation factor-15, heart-fatty acid-binding protein, brain natriuretic peptide and prognosis in children with pneumonia associated with heart failure

Abstract

Objective To investigate the relationship between serum levels of growth differentiation factor (GDF)-15, heart-fatty acid-binding protein (H-FABP) and brain natriuretic peptide (BNP) and the prognosis of children with pneumonia associated with heart failure (HF). Methods Eighty children with pneumonia associated with HF diagnosed in Children′s Hospital of Hebei Province from May 2016 to May 2018 were selected as research subjects and were enrolled into study group. And 80 healthy children who received child care in the same hospital during the same period were selected as control and were enrolled into control group. The serum levels of GDF-15, H-FABP, BNP and HF marker proteins cardiac troponin (cTnI) and creatine kinase (CK)-MB of two groups were detected by enzyme-linked immunosorbent assay (ELISA) and compared by independent-samples t test. Pearson correlation analysis was used to analyze the correlation between serum levels of GDF-15, H-FABP, BNP and HF marker protein cTnI and CK-MB. Cox proportional hazard model was used to analyze the relationship between serum levels of GDF-15, H-FABP, BNP and prognosis of children with pneumonia associated with HF. The procedures followed in this study met the requirements of World Association Declaration of Helsinki revised in 2013. The guardians of all research subjects signed clinical research informed consent. There were no statistical differences between two groups in the general clinical data, such as gender composition ratio, birth gestational age, birth age, age and so on. Results ①The serum levels of GDF-15, H-FABP, BNP, cTnI and CK-MB in study group were (5.01±0.73) ng/mL, (36.2±6.2) ng/mL, (899.8±300.3) pg/mL, (0.31±0.10) μg/L, and (36.2±5.3) U/L, respectively, which all were statistically higher than those in control group (0.59±0.10) ng/mL, (1.2±0.3) ng/mL, (21.4±4.3) pg/mL, (0.06±0.02) μg/L, (18.4±2.6) U/L, and all the differences were statistically significant (t=53.652, 50.432, 26.164, 21.931, 26.973, all P<0.001). ②Among children with pneumonia associated with HF, the serum levels of GDF-15 and BNP of both were positively correlated with serum level of cTnI (r=0.340, P=0.002; r=0.285, P=0.010). And the serum levels of GDF-15 and H-FABP both were positively correlated with serum level of CK-MB (r=0.765, P<0.001; r=0.302, P=0.006). ③Cox proportional hazard model analysis results showed that the risk of poor prognosis in children with high expression of serum GDF-15 was 2.319 times higher than that in children with low expression of serum GDF-15 (HR=2.319, 95%CI: 1.306-4.118, P=0.004). The risk of poor prognosis in children with high expression of serum H-FABP was 1.737 times higher than that in children with low expression of serum H-FABP (HR=1.737, 95%CI: 1.027-2.937, P=0.039). The risk of poor prognosis in children with high expression of serum BNP was 1.904 times higher than that in children with low expression (HR=1.904, 95%CI: 1.135-3.195, P=0.015). Conclusions Serum levels of GDF-15, H-FABP and BNP of children with pneumonia associated with HF are increased, and they are associated with poor prognosis of children with this disease. As the sample size in this study is relatively small, the relationships between these three indexes and the prognosis of children with pneumonia associated with HF, and its value in evaluating the prognosis of this disease, remain to be further confirmed by large-sample, multi-center, and randomized controlled trials. Key words: Growth differentiation factors; Fatty acid-binding proteins; Natriuretic peptide, brain; Biological markers; Pneumonia associated with heart failure; Cardiac troponin; Creatine kinase; Child