title: Determining the optimal cutoff values of plasma N-terminal pro-B-type natriuretic peptide levels for the diagnosis of heart failure in children of age up to 14 years.
abstract: BACKGROUND
  Plasma N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) is a biomarker of heart failure (HF). However, the optimal cutoff value of plasma NT-proBNP for the diagnosis of HF in children is unknown. The objective of this study was to determine the appropriate cutoff value of plasma NT-proBNP for the diagnosis of HF in children ≤14 years old.
  
  
  RESULTS
  Plasma NT-proBNP concentrations were detected in pediatric HF patients using standard clinical assays. Patients were stratified into 4 groups by age: 0-1 year, 1-3 years, 4-7 years, and 8-14 years. Case-matched healthy children were recruited as control subjects. HF was diagnosed with the use of the modified Ross score. The optimal cutoff value of plasma NT-proBNP for the diagnosis of HF was determined by analyzing receiver operating characteristic (ROC) curves and the resulting sensitivity, specificity, and Youden index (J). In healthy children, plasma NT-proBNP level and age were negatively correlated (r = -0.739; P < .001). In HF patients aged 0-1 year, 1-3 years, 4-7 years, and 8-14 years, respectively, areas under the ROC curves were 0.795, 0.786, 0.783, and 0.696; 95% confidence intervals were 0.689-0.901, 0.669-0.903, 0.662-0.904, and 0.487-0.905; and J values were 0.715, 0.708, 0.706, and 0.679. Optimal cutoff values of plasma NT-proBNP for the diagnosis of HF were 502 ng/L, 456 ng/L, 445 ng/L, and.355 ng/L.
  
  
  CONCLUSIONS
  Age-stratified analysis of plasma NT-proBNP levels in children provides new parameters for diagnosing HF.
authors.affiliation: Foshan Shunde Women and Children Health Care Hospital, Shunde, Foshan, Guangdong, P. R. China. Electronic address: 494812590@qq.com.
authors.forename: Chun-Wang
authors.initials: CW
authors.lastname: Lin
authors.affiliation: First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, P. R. China.
authors.forename: Xiang-Lin
authors.initials: XL
authors.lastname: Zeng
authors.affiliation: Foshan Shunde Women and Children Health Care Hospital, Shunde, Foshan, Guangdong, P. R. China.
authors.forename: Jin-Feng
authors.initials: JF
authors.lastname: Zhang
authors.affiliation: Foshan Shunde Women and Children Health Care Hospital, Shunde, Foshan, Guangdong, P. R. China.
authors.forename: Xiu-Hui
authors.initials: XH
authors.lastname: Meng
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: N-Terminal fragment of pro–B-type natriuretic peptide; age stratification; children up to 14 years of age; cutoff points; heart failure diagnosis