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. 2015 Nov;31(6):485-93.
doi: 10.6515/acs20141201e.

Early Elevated B-Type Natriuretic Peptide Levels are Associated with Cardiac Dysfunction and Poor Clinical Outcome in Pediatric Septic Patients

Jiunn-Ren Wu  1 , I-Chen Chen  2 , Zen-Kong Dai  1 , Jui-Feng Hung  2 , Jong-Hau Hsu  1
Affiliations

Early Elevated B-Type Natriuretic Peptide Levels are Associated with Cardiac Dysfunction and Poor Clinical Outcome in Pediatric Septic Patients

Jiunn-Ren Wu et al. Acta Cardiol Sin. 2015 Nov.

Abstract

Background: To determine the B-type natriuretic peptide (BNP) level in pediatric septic patients, and to investigate its association with cardiovascular dysfunction and clinical outcome.

Methods: Pediatric patients with sepsis or septic shock were prospectively enrolled in our pediatric intensive care unit (PICU). On day 1 of admission, plasma BNP levels were measured at the time-point of echocardiography. Myocardial dysfunction was defined as left ventricular fractional shortening (FS) < 30%. Inotropic support was quantified by inotropic scores and disease severity was assessed by Pediatric Risk of Mortality (PRISM) III scores. Therafter, associations between BNP levels and clinical parameters were analyzed.

Results: There were 94 patients (mean: 5.6 yr, range: 2 mo-17 yr) that were consecutively enrolled in this study. The median BNP level was 127 pg/ml (range: 5 to 4950 pg/ml). BNP levels were correlated with PRISM III (rho = 0.36, p = 0.001) and C-reactive protein level (r = 0.39, p = 0.001). The median BNP levels were not only higher in patients with septic shock (n = 34) than those with sepsis (n = 58) (213 vs. 54 pg/ml, p = 0.0004), but also higher in patients with myocardial dysfunction (n = 18) than those with preserved myocardial function (n = 66) (765 vs. 65 pg/ml, p < 0.001). We also found that BNP levels correlated negatively with FS (r = -0.56, p < 0.001) and positively with inotropic scores (r = 0.34, p = 0.04). Most importantly, the median BNP levels were higher in non-survivors (n = 13) than survivors (n = 81) (367 vs. 106 pg/ml, p = 0.003).

Conclusions: BNP levels are elevated in pediatric septic patients early in the disease course, and increased levels are associated with cardiovascular dysfunction and worse clinical outcome.

Key words: B-type natriuretic peptide; Cardiac function; Pediatric; Sepsis; Septic shock.

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Figures

Figure 1
Figure 1
Scatter plots showing the relationship between BNP levels and PRISM III scores (A) and CRP (B). Higher BNP levels were associated with higher PRISM III and CRP. Abbreviations are in Table 1; BNP, B-type natriuretic peptide.
Figure 2
Figure 2
Box plots showing the relationship of BNP to PICU mortality. BNP levels were higher in non-survivors. Boxes show the interquartile range with the midline indicating the median level. I-bars represent the highest and lowest values. Abbreviations are in Table 1; BNP, B-type natriuretic peptide.
Figure 3
Figure 3
Box plots showing the relationship of BNP to presence of shock (A) and cardiac dysfunction (B). BNP levels were higher in patients with septic shock, and those with cardiac dysfunction. Boxes show the interquartile range with the midline indicating the median level. I-bars represent the highest and lowest values. BNP, B-type natriuretic peptide.
Figure 4
Figure 4
Scatter plots showing the relationship between FS (A) and inotropic scores (B). Higher BNP levels were associated with lower FS and higher inotropic scores. N = 36 in B because inotropes were only administered in patients with septic shock. BNP, B-type natriuretic peptide; FS, fractional shortening.
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