Clinical utility of B-type natriuretic peptide on pediatric intensive care unit admission in predicting mechanical ventilatory/circulatory support for heart failure

Abstract

Background: Increased B-type natriuretic peptide (BNP) level is known as a predictive value for cardiac dysfunction in intensive care unit (ICU) patients. Objectives: To verify the association between BNP on admission and clinical outcomes including need for mechanical ventilatory/circulatory support and mortality in patients with heart failure (HF) in pediatric intensive care unit (PICU). Methods: Medical records of 132 HF patients admitted to PICU between February 2009 and August 2015 were reviewed for demographic, clinical, and laboratory data. Results: Among 113 patients who were finally included, mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) were used in 64 (56.6%) and 19 (16.8%) patients, respectively. Parameters associated with MV were high pediatric risk of mortality (PRISM) III score; highest vasoactive-inotropic score within 24 h of admission; elevated lactic acid, BNP, CK-MB, and troponin I levels. Parameters associated with ECMO were high PRISM III score, reduced left ventricular ejection fraction (LVEF), and elevated lactic acid and BNP levels. Only high PRISM III score and BNP were associated with mortality. The sensitivity and specificity of BNP with a cutoff value of 1848 pg/mL were 75.4% and 72.7% for MV and 89.5% and 50.0% for ECMO. Conclusions: In ICU settings, BNP levels on admission may be useful biomarkers during critical decision making including the determination of mechanical ventilatory/circulatory support.