(1497) Predictive Value of B-Type Natriuretic Peptide in Critically Ill Children

Introduction: B-type natriuretic peptide (BNP), an indicator of myocardial stretching, is utilized as a biomarker in adults for diagnosing and monitoring heart failure and other conditions. However, its diagnostic and prognostic significance in critically ill children remains uncertain. This study aimed to assess the predictive value of BNP in critically ill children.

Methods: In a retrospective single institutional study, we examined children (excluding neonates) admitted to the PICU who had their BNP levels measured within 72 hours of admission. We collected demographic, clinical, laboratory, and outcome data. We categorized the study cohort into five groups based on the quintiles of the maximum BNP value. The Kruskal-Wallis and the Chi-square tests were used to compare various variables among these five groups. To evaluate the predictive value of BNP, we constructed ROC curves, utilizing BNP level as the predictor variable for fluid resuscitation, vasoactive medication use, severe sepsis/septic shock, and mortality. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using Youden index.

Results: We analyzed 681 children with a median age of 110 (26-185) months and 55% males. The BNP ranges in five groups were, < 20, 20-71, 72-202, 203-815, and >815 pg/mL. The hospital LOS was 7 (4-14) days, and the overall mortality rate was 9.3%. The prevalence of hyperlactatemia, PRISM ROM, mechanical ventilation rate, fluid bolus, and vasoactive medication use, severe sepsis/septic shock, LOS, and mortality rate were higher in higher BNP quintile groups (p < 0.05). The AUC [95% CI] for various outcome variables were - fluid bolus: 0.613 ([0.571-0.655], p< 0.001, PPV=0.61, NPV=0.58), vasoactive medications: 0.793 ([0.751-0.834] p< 0.001, PPV=0.35, NPV=0.91), severe sepsis: 0.772 ([0.72-0.818], p< 0.00, PPV=0.32, NPV=0.92) and mortality: 0.691 ([0.621-0.760], p< 0.001, PPV=0.15, NPV=0.94) with discriminatory BNP levels between 200-250 pg/mL.

Conclusions: In critically ill children, the BNP levels demonstrate a moderate to high accuracy for predicting fluid resuscitation, vasoactive infusion, sepsis, and mortality. However, before applying these findings in clinical practice, it is crucial to validate them using multi-institutional prospective data.