Early elevations in B-type natriuretic peptide levels are associated with poor clinical outcomes in pediatric acute lung injury.
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.
Reel
Bhupinder
B
Department of Pediatrics, University of California, San Francisco, California, USA.
Oishi
Peter E
PE
Hsu
Jong-Hau
JH
Gildengorin
Ginny
G
Matthay
Michael A
MA
Fineman
Jeffrey R
JR
Flori
Heidi
H
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
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain