Department of Pediatrics, Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi, India.
Pediatr Cardiol. 2023 Dec;44(8):1716-1720. doi: 10.1007/s00246-023-03259-x. Epub 2023 Aug 11.
N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been used as a tool for diagnosis, severity assessment and prognostication of congestive heart failure (CHF) in adults, with specific cut off values for diagnosis and denoting points of intervention. However, there is scarcity of paediatric literature regarding role of NT-proBNP as a marker of heart failure severity and prognostication. So, this study was done to assess the utility of NT-proBNP as a marker of severity of heart failure in children with congenital heart diseases. Single centre, prospective observational study. Children (1 month to 5 years), with congenital heart disease, admitted in the paediatric wards with varying severity of CHF were enrolled. Heart failure severity grading was done according to Laer modification of Ross Classification at the time of presentation to hospital and children were classified as having no/grade I CHF (score: 0-2); mild/grade II CHF (score 3-6); moderate/grade III CHF (score 7-9) or severe/grade IV CHF (score 10-12). NT-proBNP levels were measured within 24 h of admission. Eighty children with congenital heart disease were enrolled in this study. As per modified Ross Classification, 11 had grade I/No heart failure (13.7%), 32 children had grade II/mild heart failure (40%), 36 had grade III/moderate heart failure (45%) and only 1 had grade IV/severe heart failure (1.25%). The median NT-proBNP levels (IQR) in the above mentioned grades of heart failure were found to be 321.11 (211.1-411.78 pg/ml), 750.62 (474.62-995.2 pg/ml), 4159.61 (1440.59-11,857 pg/ml) and 11,320.34 pg/ml, respectively. Seven children (8.75%) expired. Median NT-proBNP value in seven children who died was significantly higher than those who survived [median (IQR): 11,681.01 pg/ml (10,092.72-14,754 pg/ml) vs 839.4 pg/ml (456.67-3288.09 pg/ml), p value < 0.001]. NT-proBNP level of 520.2 pg/ml predicted grade II (mild heart failure) or more severe grades of heart failure with Sensitivity, Specificity, Negative Predictive Value and Positive Predictive Value of 83%, 91%, 57.1% and 98%, respectively. NT-proBNP levels increase progressively with increasing severity of CHF and can be used as a marker of severity of heart failure in children with congenital heart disease presenting with CHF.
N 端脑利钠肽前体（NT-proBNP）已被用作诊断、评估充血性心力衰竭（CHF）严重程度和预后的工具，具有特定的诊断截断值和干预切点。然而，关于 NT-proBNP 作为心力衰竭严重程度和预后标志物在儿科中的作用，相关的儿科文献非常有限。因此，本研究旨在评估 NT-proBNP 作为儿童先天性心脏病心力衰竭严重程度标志物的作用。
单中心前瞻性观察研究。入选在儿科病房住院的先天性心脏病儿童，其心力衰竭严重程度不一。心力衰竭严重程度分级根据 Laer 改良 Ross 分类在入院时进行，儿童被分为无/Ⅰ级心力衰竭（评分：0-2 分）；轻度/Ⅱ级心力衰竭（评分 3-6 分）；中度/Ⅲ级心力衰竭（评分 7-9 分）或重度/Ⅳ级心力衰竭（评分 10-12 分）。入院后 24 小时内测量 NT-proBNP 水平。本研究共纳入 80 例先天性心脏病患儿。根据改良 Ross 分类，11 例为Ⅰ/无心力衰竭（13.7%），32 例为Ⅱ/轻度心力衰竭（40%），36 例为Ⅲ/中度心力衰竭（45%），仅 1 例为Ⅳ/重度心力衰竭（1.25%）。上述心力衰竭分级患儿的中位 NT-proBNP 水平（IQR）分别为 321.11（211.1-411.78pg/ml）、750.62（474.62-995.2pg/ml）、4159.61（1440.59-11857pg/ml）和 11320.34pg/ml。有 7 例患儿（8.75%）死亡。7 例死亡患儿的中位 NT-proBNP 值明显高于存活患儿[中位数（IQR）：11681.01pg/ml（10092.72-14754pg/ml）比 839.4pg/ml（456.67-3288.09pg/ml），p 值<0.001]。NT-proBNP 水平为 520.2pg/ml 可预测Ⅱ级（轻度心力衰竭）或更严重的心力衰竭分级，其敏感性、特异性、阴性预测值和阳性预测值分别为 83%、91%、57.1%和 98%。
随着充血性心力衰竭严重程度的增加，NT-proBNP 水平逐渐升高，可作为儿童先天性心脏病合并充血性心力衰竭时心力衰竭严重程度的标志物。
