title: Early elevations in B-type natriuretic peptide levels are associated with poor clinical outcomes in pediatric acute lung injury.
abstract: OBJECTIVE
  To determine B-type natriuretic peptide (BNP) levels in infants and children with acute lung injury (ALI), and to investigate associations between BNP levels and clinical outcome.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  After informed consent, plasma was collected from 48 pediatric patients on day 1 of ALI.
  
  
  METHODS
  Plasma BNP levels were measured by immunoassay on day 1 of ALI in 48 pediatric patients. Associations between BNP levels and outcome were determined.
  
  
  RESULTS
  The mean PaO(2)/FiO(2) at the onset of ALI was 155 (+/-74) and BNP values ranged from 5 to 2,060 pg/ml with a mean of 109 (+/-311). BNP levels were inversely correlated with ventilator-free days (Spearman rho -0.30, P = 0.04), and positively correlated with exhaled tidal volume (Spearman rho 0.44, P = 0.02). BNP levels were higher in patients receiving inotropic support (n = 12) than patients not receiving inotropic support (n = 33, P = 0.02). BNP levels were correlated with PRISM III scores (Spearman rho 0.55, P < 0.001) and PELOD scores (Spearman rho 0.4, P = 0.006). Mortality for the cohort was 15%. BNP levels were higher in non-survivors (n = 7) than survivors (n = 41, P = 0.055).
  
  
  CONCLUSIONS
  BNP levels are elevated in children with ALI/ARDS early in the disease course, and increased levels are associated with worse clinical outcome.
authors.affiliation: Department of Pediatrics, University of California, San Francisco, California, USA.
authors.forename: Bhupinder
authors.initials: B
authors.lastname: Reel
authors.forename: Peter E
authors.initials: PE
authors.lastname: Oishi
authors.forename: Jong-Hau
authors.initials: JH
authors.lastname: Hsu
authors.forename: Ginny
authors.initials: G
authors.lastname: Gildengorin
authors.forename: Michael A
authors.initials: MA
authors.lastname: Matthay
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Fineman
authors.forename: Heidi
authors.initials: H
authors.lastname: Flori
mesh_terms: D055371:Acute Lung Injury / Q000097:blood*; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000097:blood*; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood*; D016019:Survival Analysis; D013990:Tidal Volume
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain