Key result
Admission NT-proBNP >1,500 pg/mL in children with severe hand, foot, and mouth disease was associated with a significantly increased risk of 3-day mortality (HR 22.5; 95% CI 3.56-142.66).
Why the study?
Does elevated admission NT-proBNP predict 3-day mortality in children hospitalized with severe hand, foot, and mouth disease?
Cohort (n=295)
No
Does elevated admission NT-proBNP predict 3-day mortality in children hospitalized with severe hand, foot, and mouth disease?
Answers are grounded in this paper and cite their sources.
Admission NT-proBNP > 1,500 pg/mL is a strong independent predictor of short-term mortality in children with severe hand, foot, and mouth disease.
OBJECTIVE: Our goal is to determine the prognostic value of serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP), leukocytosis, and hyperglycemia in patients with severe hand, foot, and mouth disease (HFMD). DESIGN: This is a prospective cohort study conducted from March 2011 through October 2012 at Hunan Children's Hospital. SETTING: Hunan Children's Hospital, a large children's teaching hospital with 1,500-beds located in the Changsha region of Hunan Province in China. PATIENTS: 295 children who were presented with clinical manifestation of severe HFMD, and required hospitalization. INTERVENTIONS: Standard supportive treatment for HFMD as recommended by the national guidelines. MEASUREMENTS: Admission blood samples were analyzed for NT-proBNP, leukocyte count, and serum glucose. Independent prognostic value of NT-proBNP for predicting mortality was evaluated using the Cox proportional hazard model adjusting for various covariates. MAIN RESULTS: Area under the curve of receiver operating characteristic (AUROC) analysis suggested that a serum concentration of NT-proBNP concentration more than 1,500 pg/mL is an optimal cutoff point. Twenty-four patients (8.1%) had an NT-proBNP more than 1,500 pg/mL, and a 3-day mortality of 46% (11/24). Adjusted for tachycardia, tachypnea, hypertension, hyperglycemia, leukocytosis, and conscious disturbance on presentation, elevated NT-proBNP was associated with a 22.5-fold (95% confidence interval, 3.56-142.66) increased risk of 3-day mortality. We have further improved the specificity and AUROC values by the HFMD laboratory score, which combines NT-proBNP, leukocytosis, and hyperglycemia. CONCLUSIONS: Routine admission surveillance for NT-proBNP is useful for identifying patients with HFMD at risk for mortality. Further studies are needed to determine whether early intervention in patients with highly elevated NT-proBNP can improve outcome.
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Lee et al. (2015) conducted a cohort in Severe hand, foot, and mouth disease (n=295). Elevated NT-proBNP (>1,500 pg/mL) vs. NT-proBNP ≤1,500 pg/mL was evaluated on 3-day mortality (HR 22.5, 95% CI 3.56-142.66). Admission NT-proBNP >1,500 pg/mL in children with severe hand, foot, and mouth disease was associated with a significantly increased risk of 3-day mortality (HR 22.5; 95% CI 3.56-142.66).
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