The value of N-terminal pro-Brain Natriuretic Peptide in children with severe hand-foot-mouth disease

Abstract

Objective To explore the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in assessing severity and predicting prognosis in children with severe hand-foot-mouth disease (HFMD). Methods A total of 119 eligible children with severe HFMD admitted in the pediatric intensive care unit were enrolled in this retrospective study from March 2012 to March 2014. According to NT-proBNP level, children were divided into ≤ 500 pg/mL group (n =70) and >500 pg/mL group (n =49) ; whereas according to severity, children were divided into severe-type (n =74) and critical-type (n =45) ; and based on 28 days outcome in children with critical-type HFMD, children were divided into fatal group (n =27) and survival group (n =18). The chi-square test, two-samplet test, rank sum test Pearson or Spearman' s correlation , area under the receiver operating characteristic curve (AUC) were used to analyze119 children with severe hand-foot-mouth disease (HFMD). Results Within 24 hours after admission, NT-proBNP>500 pg /mL group had higher rates of fever, abnormal breathing, abnormal heart rate, abnormal systolic blood pressure, capillary refill time >2 seconds and higher levels of laboratory biomarkers than NT-proBNP ≤ 500 pg/mL group (P <0.05) ; and during hospitalization, the rates of pulmonary edema, pulmonary hemorrhage and death also higher than NT-proBNP ≤ 500 pg/mL group (P <0.05 ). NT-proBNP, BS, WBC were higher in critical-type group than severe-type group (P =0.00) , while the PCIS (pediatric critical illness score) was lower in critical-type group (χ2 =14.70 , P =0.00). NT-proBNP was higher in fatal group than that in survival group (t =-2.60 , P =0.01) , PCIS was lower in fatal group (Z =2.70 , P =0.01) ; and there were no statistically significant differences in BS and WBC between fatal and survival groups (BS : t =-0.60 , P =0.55 ; WBC : t =-0.72 , P =0.48). NT-proBNP, BS and WBC were negatively correlated with PCIS (r values were -0.58 , -0.46, -0.56 , P values were 0.00). The AUCs of NT-proBNP, BS, WBC and PCIS to determine the severity of severe HFMD children were 0.94, 0.80, 0.74, and 0.97, respectively; and to predict 28 days survival in critical-type HFMD were 0.73 , 0.56 , 0.53 , and 0.73 , respectively. Conclusions Higher level of NT-proBNP could prompt cardiopulmonary involvement. NT-proBNP could reflect the severity of illness and served as a sensitive marker in predicting 28-day survival, being better than BS and WBC. Key words: N-terminal pro-brain natriuretic peptide; Severe; Hand-foot-mouth disease; Cardiopulmonary function; Pediatric critical illness score; Blood sugar; White blood cell; Prognosis