Zhang Zhen, Li Yuna, Yang Chunfeng, Li Yumei
Department of PICU, Children's Medical Center, The First Hospital of Jilin University, Changchun, China.
Pediatr Res. 2024 Oct 23. doi: 10.1038/s41390-024-03666-7.
There is evidence that a high level of BNP is associated with poorer outcomes in patients with cardiac diseases, but few data are available concerning BNP and all-cause mortality in pediatric population.
Using the 2010-2018 pediatric intensive care database, we conducted a retrospective study on patients aged 28 days to 18 years, analyzing post-admission BNP measurements. Through two-piecewise regression to identify inflection points, and multivariable logistic regression, we investigated BNP's association with all-cause mortality. We also developed a multivariable-adjusted restricted cubic spline model to explore BNP's non-linear correlation with mortality.
In a study of 3220 patients, the overall all-cause mortality rate was 6.7%, with rates across BNP quartiles (Q1-Q4) significantly differing, highlighting a notable increase in mortality at higher BNP levels (P < 0.001). Specifically, patients with BNP ≥ 10,170 pg/ml had an adjusted mortality odds ratio (OR) of 2.017 (95% CI 1.265-3.217; P = 0.0032). Analysis confirmed a non-linear relationship between BNP levels and mortality, with log2 BNP associated with increased risk (OR1.28, 95% CI 1.19-1.38; P < 0.001). Subgroup analyses further revealed that very high BNP levels, especially in infants, with lactate ≥2.0 mmol/L, or CKMB ≥ 45 μ/L.
BNP level was associated with all-cause mortality, especially for the patients with BNP ≥ 10,170 pg/ml.
This study explored the non-linear association between BNP levels and all-cause mortality in the PICU, finding a significant association among patients with BNP levels above 10,170 pg/ml. The study revealed that higher BNP levels are associated with increased mortality in critically ill children, including those with non-cardiac diseases. This research provides new data on a Southern Chinese population, previously unstudied, enriching the existing body of knowledge. While most studies have focused on adult cardiac patients, this research highlights the importance of BNP as a prognostic tool in the PICU, including non-cardiac cases, adding to the literature. This study furnishes novel clinical evidence supporting the monitoring of BNP concentrations within the PICU, aiding in prognostic predictions and the development of tailored treatment plans for patients.
有证据表明，高水平的脑钠肽（BNP）与心脏病患者较差的预后相关，但关于儿童人群中BNP与全因死亡率的数据却很少。
利用2010 - 2018年儿科重症监护数据库，我们对年龄在28天至18岁的患者进行了一项回顾性研究，分析入院后BNP的测量值。通过两段式回归确定拐点，并进行多变量逻辑回归，我们研究了BNP与全因死亡率的关联。我们还建立了一个多变量调整的受限立方样条模型，以探讨BNP与死亡率的非线性相关性。
在对3220名患者的研究中，总体全因死亡率为6.7%，BNP四分位数（Q1 - Q4）的死亡率显著不同，表明BNP水平较高时死亡率显著增加（P < 0.001）。具体而言，BNP≥10,170 pg/ml的患者调整后的死亡比值比（OR）为2.017（95%可信区间1.265 - 3.217；P = 0.0032）。分析证实BNP水平与死亡率之间存在非线性关系，log2 BNP与风险增加相关（OR 1.28，95%可信区间1.19 - 1.38；P < 0.001）。亚组分析进一步显示，非常高的BNP水平，特别是在婴儿中，伴有乳酸≥2.0 mmol/L或肌酸激酶同工酶（CKMB）≥45 μ/L。
BNP水平与全因死亡率相关，尤其是对于BNP≥10,170 pg/ml的患者。
本研究探讨了儿科重症监护病房（PICU）中BNP水平与全因死亡率之间的非线性关联，发现BNP水平高于10,170 pg/ml的患者之间存在显著关联。该研究表明，较高的BNP水平与危重症儿童（包括患有非心脏疾病的儿童）的死亡率增加相关。这项研究提供了关于中国南方人群的新数据，此前未被研究过，丰富了现有知识体系。虽然大多数研究集中在成年心脏病患者，但本研究强调了BNP作为PICU中（包括非心脏病例）预后工具的重要性，为文献增添了内容。本研究提供了新的临床证据，支持在PICU中监测BNP浓度，有助于预后预测和为患者制定个性化治疗方案。
