N-terminal pro-B-type natriuretic peptide for the prognostic prediction of severe enterovirus 71-associated hand, foot, and mouth disease

Abstract

Objective: The aim of this study was to determine whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) can predict impending brainstem encephalitis, pulmonary edema, pulmonary hemorrhage, cardiopulmonary failure, and death in children with severe enterovirus 71 (EV71)-associated hand, foot, and mouth disease (HFMD).

Methods: Plasma NT-proBNP levels of 282 children with severe EV71-associated HFMD were measured.

Results: NT-proBNP levels were significantly higher in patients with elevated blood glucose (>7.8 mmol/l) and increased white blood cell counts (>14×10⁹/l). HFMD patients who had no complications had significantly lower NT-proBNP values than patients who died or had complications (p<0.05). The area under the receiver operating characteristic (ROC) curve was 0.73, 0.87, 0.91, 0.93, and 0.92 to discriminate between patients with and without brainstem encephalitis, pulmonary edema, pulmonary hemorrhage, circulatory failure, and death, respectively, using NT-proBNP. An NT-proBNP cut-off value of ≥1300pg/ml demonstrated a high sensitivity (85.00%) and specificity (93.51%) for predicting death in critical HFMD patients. Children with severe EV71-associated HFMD and NT-proBNP measurements ≥1300pg/ml had significantly worse overall survival compared to those with levels <1300pg/ml (p<0.05).

Conclusions: NT-proBNP levels may be able to predict complications and mortality in children with severe EV71-associated HFMD disease in the intensive care unit. Serum NT-proBNP values ≥1300pg/ml on admission could be indicative of circulatory failure and increased mortality.

Keywords: Cardiopulmonary failure; Hand; N-terminal pro-B-type natriuretic peptide; and mouth disease; foot.