Significance of N-terminal pro-B-type natriuretic peptide in evaluating complications and prognosis of patients with severe hand-foot-and-mouth disease

Abstract

Objective To investigate the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in evaluating the complications and prognosis of children with severe hand-foot-and-mouth disease(HFMD). Methods The children with severe HFMD treated in the Intensive Care Unit of Hunan Provincial Children's Hospital from January of 2012 to December of 2013 were recruited and the levels of serum NT-proBNP were detected on admission.Compared with the difference of NT-proBNP between patients with or without brainstem encephalitis, pulmonary edema, pneumorrhagia and the dead cases were compared.The receiver operating characteristic (ROC) curve of NT-proBNP was made. Results The average value of NT-proBNP in brainstem encephalitis was 4 966.71 ng/L, and that without brainstem encephalitis was 407.12 ng/L.The average value of NT-proBNP in pulmonary edema was 7 043.42 ng/L, and that without pulmonary edema was 484.52 ng/L.The average value of NT-proBNP in pneumorrhagia was 7 828.03 ng/L, and that without pneumorrhagia was 605.18 ng/L, the average value of NT-proBNP in circulatory failure was 8 325.55 ng/L, and that without circulatory failure was 602.23 ng/L.The average value of NT-proBNP in the dead cases was 9 042.60 ng/L, and the average value of survivors was 686.54 ng/L.There were significant differences in the levels of Lg(NT-proBNP) between the groups with complications or death and the group without complications or survivals(P<0.05). The levels of serum NT-proBNP and the area under prognostic ROC curve of brainstem encephalitis, pulmonary edema, pneumorrhagia, circulatory failure, and death respectively was 0.72, 0.85, 0.89, 0.92 and 0.91, respectively.Its sensitivity and specificity were both high if used for forecasting different complications and prognosis by the critical value of 550 ng/L. Conclusions The condition of HFMD was more serious with higher level of NT-proBNP.The level of NT-proBNP is valuable for predicting the prognosis.The level of NT-proBNP higher than 550 ng/L is a signal of patients who suffer from kinds of serious complications like pulmonary edema, pneumorrhagia, circulatory failure and death. Key words: Severe hand-foot-and-mouth disease; N-terminal pro-B-type natriuretic peptide; Pulmonary edema; Prognosis