Published online September 11, 2006
PEDIATRICS Vol. 118 No. 4 October 2006, pp. e1165-e1168 (doi:10.1542/peds.2006-0569)

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ARTICLE

Comparison of N-terminal Pro-B-Type Natriuretic Peptide Levels in Critically Ill Children With Sepsis Versus Acute Left Ventricular Dysfunction

Iris Fried, MD^a, Benjamin Bar-Oz, MD^b, Nurit Algur, MSc^c, Elchanan Fried, MD^d, Sagui Gavri, MD^e, Ido Yatsiv, MD^f, Zeev Perles, MD^e, Azaria J. J. T. Rein, MD^e, Zeev Zonis, MD^g, Roman Bass, MD^f and Amiram Nir, MD^h

^a Departments of Pediatrics
^b Neonatology
^d Internal Medicine
^e Pediatric Cardiology Unit
^f Pediatric Intensive Care Unit, Hadassah and the Hebrew University Medical Center, Jerusalem, Israel
^c Biochemistry Laboratory
^h Pediatric Cardiology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
^g Pediatric Intensive Care Unit, Western Galilee Hospital, Naharia, Israel

OBJECTIVE. N-terminal pro-B-type natriuretic peptide has been shown to be a marker for cardiac dysfunction. The peptide level is also elevated in patients with sepsis. The purpose of this study was to assess whether N-terminal pro-B-type natriuretic peptide levels can differentiate pediatric patients with sepsis from patients with acute left ventricular dysfunction.

PATIENTS AND METHODS. Pediatric patients admitted to an ICU with sepsis or acute left ventricular dysfunction were evaluated clinically, and the grade of systemic inflammatory-response syndrome was determined. Echocardiography was performed, and their levels of N-terminal pro-B-type natriuretic peptide were measured. The N-terminal pro-B-type natriuretic peptide level was also measured in patients with simple febrile illness.

RESULTS. There were 10 patients with sepsis and 10 with acute left ventricular dysfunction. The age of the patients was similar, and systemic inflammatory-response syndrome grading was not different (sepsis: 2.8 ± 0.4; acute left ventricular dysfunction: 2.6 ± 0.7). N-terminal pro-B-type natriuretic peptide levels were elevated in patients with sepsis (median: 6064 pg/mL; range: 495–60417 pg/mL) but were significantly higher in patients with acute left ventricular dysfunction (median: 65630 pg/mL; range: 15125–288000). The area under the receiver operating characteristics curve for the diagnosis of acute left ventricular dysfunction was 0.9. N-terminal pro-B-type natriuretic peptide levels of patients with sepsis and impaired systolic function were not different from those of patients with sepsis and normal systolic function. The N-terminal pro-B-type natriuretic peptide levels of 20 patients with simple febrile illness were significantly lower.

CONCLUSIONS. N-terminal pro-B-type natriuretic peptide levels are elevated in pediatric patients with sepsis but are higher in some, but not all, patients with acute left ventricular dysfunction. The overlap between N-terminal pro-B-type natriuretic peptide levels in sepsis and acute left ventricular dysfunction precludes the use of the peptide's level as a sole means to differentiate between these conditions. Excessive elevation in N-terminal pro-B-type natriuretic peptide levels, however, suggests cardiac etiology for acute hemodynamic deterioration in infants and children.

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Key Words: B-type natriuretic peptide • left ventricular dysfunction • sepsis • infants • children

Abbreviations: BNP—B-type natriuretic peptide • NT-proBNP—N-terminal pro-B-type natriuretic peptide • LVD—left ventricular dysfunction • SIRS—systemic inflammatory-response syndrome

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Accepted May 23, 2006.

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