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Concentrations of brain natriuretic peptide in the plasma predicts outcomes of treatment of children with decompensated heart failure admitted to the Intensive Care unit

Published online by Cambridge University Press:  18 June 2007

Lin-Hua Tan ,
John L. Jefferies ,
Jian-Feng Liang ,
Susan W. Denfield ,
William J. Dreyer ,
Antonio R. Mott ,
Michelle A. Grenier ,
Heather A. Dickerson ,
Jack F. Price  and
Jeffrey A. Towbin
...Show all authors
Lin-Hua Tan
Affiliation:
Department of Surgical Intensive Care Unit, Children’s Hospital College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
John L. Jefferies
Affiliation:
Division of Advanced Heart Failure, Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas, United States of America Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Jian-Feng Liang
Affiliation:
Department of Surgical Intensive Care Unit, Children’s Hospital College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
Susan W. Denfield
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
William J. Dreyer
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Antonio R. Mott
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Michelle A. Grenier
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Heather A. Dickerson
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Jack F. Price
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Jeffrey A. Towbin
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Ching-Nan Ou
Affiliation:
Department of Pathology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Anthony C. Chang*
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
*
Correspondence to: Anthony C. Chang, MD, Director, Children’s Heart Institute, Children’s Hospital of Orange County, 455 S. Main Street, Orange, CA 92868, USA. Tel: +1 714 221 5500; Fax: +1 714 221 5515; E-mail: achang@choc.org
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Abstract

Objectives

It is known that levels of brain natriuretic peptide predict outcomes of treatment for adults with decompensated heart failure. We hypothesized that it could predict outcomes in children with this condition.

Methods

We divided retrospectively 82 patients with serial measurements of brain natriuretic peptide into 3 groups: those who survived and did not need readmission within less than 60 days; those who survived but needed readmission within less than 60 days; and those who died in hospital or within less than 60 days. Initial and final levels of the peptide correlated with adverse outcomes.

Results

The percent change in level of the peptide was minus 78 percent, minus 38 percent, and 138 percent in the readmission-free group, the readmitted, and nonsurviving groups, respectively. Final levels were significantly lower in the readmission-free group than in the readmitted and nonsurviving groups (p equals 0.013 and p is less than 0.00001, respectively) and in the readmitted group than in the nonsurvivors (p equals 0.013). On univariate analysis, the final level, the change in level, and the percentage change in level significantly predicted outcomes (p equals 0.0002, 0.0072 and 0.0005, respectively). On multivariate analysis, only the final level of the peptide significantly predicted outcomes (p equals 0.01).

Conclusions

A final level of brain natriuretic peptide of greater than or equal to 760 picograms per millilitre strongly predicted an adverse outcome. Patients with higher final levels may be at higher risk of death and readmission, suggesting that this variable effectively predicts the response to treatment and prognosis in children with heart failure.

Keywords

Heart diseaseneurohormonal markersprognosispaediatrics
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 4 , August 2007 , pp. 397 - 406
Copyright
Copyright © Cambridge University Press 2007

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