title: B-type natriuretic peptide as a parameter for pulmonary hypertension in children. A systematic review.
abstract: Pulmonary hypertension (PH) is a life-threatening disease with a high mortality rate and a broad variety of underlying etiologies. The current golden standard for diagnosing PH and monitoring efficiency of treatment is right heart catheterization. As an alternative, serum biomarkers have been suggested. Cardiac troponin T (TnT), brain natriuretic peptide (BNP), and NT-proBNP seem the most potential. The aim of this systematic review was to evaluate the current literature on the prognostic value of these biomarkers in children with PH and their usefulness as a diagnostic tool. A systematic literature search yielded 14 studies on patients ≤18 years with proven PH with (NT-pro)BNP or TnT as primary outcome. TnT is suggested to be a promising biomarker, but its usefulness in clinical practice has not been proven. The levels of (NT-pro)BNP seemed to be reliable within one PH category, but differed significantly between categories. NT-proBNP showed a good correlation with mortality and might have a prognostic value.
  
  
  CONCLUSIONS
  The lack of absolute levels makes (NT-pro)BNP unsuitable as a diagnostic marker, but in view of the relative changes, it could be used to monitor patients. Further investigation should explore differences in normal (NT-pro)BNP levels between the different categories of PH.
  
  
  BACKGROUND
  • Pulmonary hypertension is a life-threatening disease. Diagnosis can be challenging in children; the current diagnostic options-right heart catheterization and echocardiography-are invasive and/or investigator-dependent procedures. • Biomarkers could be useful in this context because they are investigator independent and easy to obtain through blood samples. Brain natriuretic peptide (BNP) and its N-terminal cleavage product (NT-proBNP) seem to be the most promising. The value of these biomarkers in the diagnostic approach of PH has already been investigated in adults, with promising results. Pediatric studies are still scarce. What is new: • The levels of BNP and NT-proBNP in pediatric patients differ strongly between the different categories of PH. Within the same category, the levels are more or less equal. • The relative changes could render them a prognostic marker in the follow-up of a certain individual patient. At this moment there is not enough evidence to rely on BNP or NT-proBNP in clinical treatment of patients with PH.
authors: Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Postbox 2060, Room Sk-3232, 3000 CB, Rotterdam, The Netherlands. c.tenkate@erasmusmc.nl.
authors: Chantal A
authors: CA
authors: Ten Kate
authors: Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Postbox 2060, Room Sk-3232, 3000 CB, Rotterdam, The Netherlands. d.tibboel@erasmusmc.nl.
authors: Dick
authors: D
authors: Tibboel
authors: Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Postbox 2060, Room Sk-3232, 3000 CB, Rotterdam, The Netherlands. u.kraemer@erasmusmc.nl.
authors: Ulrike S
authors: US
authors: Kraemer
mesh_terms: D015415:Biomarkers / Q000097:blood; D002648:Child; D014943:Global Health; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Biological markers; Natriuretic peptide; Pulmonary hypertension; Troponin