Pediatric Critical Care Medicine:
May 2014 - Volume 15 - Issue 4_suppl - p 145
preliminary results of plasma b-type natriuretic peptide study in children with severe enterovirus 71 infection
Jan, S.L.; Chan, S.C.; Fu, Y.C.; Lin, M.C.; Hwang, B.
ABSTRACT
Background and aims: Severe enterovirus 71 (EV71) infection in children can result in high morbidity and mortality. B-type natriuretic peptide (BNP) is a sensitive and specific biomarker of myocardial stress.
Aims: The purpose of this study was to use plasma BNP for detection of EV71 infection with cardiac involvement.
Methods: A total of 53 children, aged 2.5 ± 1.7 years, were studied. Patients were divided into three groups. Group I comprised 30 normal control patients. Group II included 20 patients with EV71-stage 2 infection, and group III included 3 patients with EV71-stage 3 infection. The demographic data, laboratory results and plasma BNP levels were statistically analyzed.
Results: All group II patients recovered completely without neurological sequelae. Two patients in group III were rescued by extracorporeal life support and successfully weaned off. All group III patients survived without cardiac complications. The group III patients had higher troponin-I, creatine kinase-MB fraction, BNP level and BNP z-score than those of other groups. The median BNP values were < 5, 9.5 and 238 pg/mL, and median of BNP z-scores were -2.02, -0.22, and 6.11 in the three groups, respectively. Using a BNP cut-off value of 100 or a BNP z-score of 4.56 to identify cases with concomitant severe EV71 infection and acute heart failure, the sensitivity and specificity were 100% and 100%, respectively.
Conclusions: Children with severe EV71 infection have varying degrees of myocardial stress. Plasma BNP is a sensitive and reliable cardiac biomarker for detection of cardiac involvement in children with severe EV71 infection.