title: N-terminal pro B-type natriuretic peptide levels in infants and children with acute non-cardiac diseases.
abstract: BACKGROUND
  Cardiac patients express elevated levels of B-type natriuretic peptide and the amino terminal segment of its prohormone (NT-proBNP). However, there are non-cardiac causes of NT-proBNP level elevation.
  
  
  OBJECTIVE
  To determine the upper limit of NT-proBNP for pediatric patients with acute non-cardiac disease.
  
  
  METHODS
  We compared NT-proBNP concentrations in children with acute non-cardiac, mostly febrile disease with concentrations in children with acute cardiac disease and in healthy children. We used the Student t-test and Mann-Whitney test for group comparisons, and Pearson's and Spearman's correlation coefficients to test relationships between variables.
  
  
  RESULTS
  In 138 patients with acute non-cardiac diseases (mean age 3.7 years, 53% male), median NT-proBNP concentration was 162 pg/ml, upper limit (95% percentile) 1049 pg/ml. The level did not vary significantly by disease category; was negatively correlated with weight, weight percentile, age and hemoglobin level; and positively correlated with creatinine level. Multivariant analysis showed weight to be the only factor influencing NT-proBNP level. Levels were higher in children with acute non-cardiac diseases versus healthy children (median 88 pg/ml, P < 0.001, n = 59), and lower than levels in patients with acute cardiac disease (median 29,986 pg/ml, P < 0.001, n=30). Receiver operating characteristic analysis showed good NT-proBNP performance for differentiation between children with acute cardiac versus non-cardiac disease (area under the curve 0.958), at a cutoff of 415 pg/ml.
  
  
  CONCLUSIONS
  NT-proBNP levels are higher in children with acute non-cardiac diseases than in healthy children, but lower than in children with acute cardiac disease. NT-proBNP negatively correlated with weight and weight percentile.
authors.affiliation: Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: Inbar
authors.initials: I
authors.lastname: Nevo
authors.forename: Mati
authors.initials: M
authors.lastname: Erlichman
authors.forename: Nurit
authors.initials: N
authors.lastname: Algur
authors.forename: Amiram
authors.initials: A
authors.lastname: Nir
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000097:blood* / Q000175:diagnosis; D005500:Follow-Up Studies; D006331:Heart Diseases; D006801:Humans; D007118:Immunoassay; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain