A Pilot Study of the Association of Amino-Terminal Pro-B-Type Natriuretic Peptide and Severity of Illness in Pediatric Septic Shock

Objectives: Biomarkers that can measure illness severity and predict the risk of delayed recovery may be useful in guiding pediatric septic shock. Amino-terminal pro-B-type natriuretic peptide has not been assessed in pediatric septic patients at the time of presentation to the emergency department prior to any interventions. The primary aim was to assess if emergency department amino-terminal pro-B-type natriuretic peptide is associated with worse outcomes and severity of illness. Design: Prospective observational pilot study. Settings: Tertiary free-standing children’s hospital. Patients: Children 0–17 years old with a diagnosis of septic shock were enrolled. Patients with preexisting cardiac and renal dysfunction were excluded. Interventions: None. Measurements and Main Results: Amino-terminal pro-B-type natriuretic peptide analysis was performed on samples obtained in the emergency department prior to any intervention. The association between biomarkers and clinical outcomes and illness severity using Pediatric RISk of Mortality 3 were assessed. Eighty-two patients with septic shock underwent analysis. The median (interquartile range) amino-terminal pro-B-type natriuretic peptide levels was 394 pg/mL (102–1,392 pg/mL). Each decile change increase in amino-terminal pro-B-type natriuretic peptide was associated with a change in ICU length of stay by 8.7%, (95% CI, 2.4–15.5), hospital length of stay by 5.7% (95% CI, 0.4–11.2), organ dysfunction by 5.1% (95% CI, 1.8–8.5), a higher inotropic score at 12, 24, and 36 hours, and longer time requiring vasoactive agents. There was a significant correlation between baseline amino-terminal pro-B-type natriuretic peptide and the Pediatric RISk of Mortality 3 score (Spearman rho = 0.247; p = 0.029). Conclusions: This pilot study shows an association between emergency department amino-terminal pro-B-type natriuretic peptide on presentation and worse septic shock outcomes and amino-terminal pro-B-type natriuretic peptide levels correlates with an ICU severity score. Dr. Melendez disclosed that Roche Diagnostics Corporation provided the biomarker assays that were used for analysis. All analyses were performed at Boston Children’s Hospital by the hospital clinical laboratory. Roche was not involved in study development, performance of assays, analysis or interpretation of results, nor in preparation of the article. Dr. Melendez received support for article research from the National Institutes of Health. Dr. Bachur received funding from UptoDate (editor, royalties), Wolters-Kluwer (textbook royalties), American Board of Pediatrics (editor), and Astute Medical (research support for appendicitis biomarker research). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: emelend1@jhmi.edu ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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