Prognostic Value of Blood Ammonia, Lactate, and Brain Natriuretic Peptide in Pediatric Patients With Sepsis: A Prospective, Observational Study

Background: Early identification of children with sepsis who are at risk of adverse outcomes is essential for timely intervention and optimal management.Objectives: To evaluate the prognostic significance of serum lactate, blood ammonia, and brain natriuretic peptide (BNP) levels in children with sepsis admitted to the Pediatric Intensive Care Unit (PICU).Methods: This prospective cohort observational study was conducted in the PICU of the Department of Paediatrics at the Indira Gandhi Institute of Medical Sciences, Patna, over 18 months.Seventy-nine children aged 1 month to 14 years with sepsis were enrolled.Serial measurements of serum lactate and blood ammonia were obtained on day 0, day 3, and day 7, while BNP levels were measured on day 0 and day 3. Clinical outcomes were recorded, and prognostic accuracy was assessed with receiver operating characteristic curve analysis.Results: Of the 73 patients included in the final analysis, 22 (30.1%)died.Non-survivors demonstrated higher levels of lactate, ammonia, and BNP than survivors.The area under the receiver operating characteristic curve (AUROC) for admission lactate was 0.741, with a cutoff of >3.29 mmol/L, a sensitivity of 54.55%, and a specificity of 92.16%.Ammonia demonstrated an AUROC of 0.713, while BNP had the highest AUROC (0.933) for predicting in-hospital mortality.Conclusion: Lactate, ammonia, and BNP demonstrated prognostic associations with in-hospital mortality in children with sepsis.BNP showed the highest AUROC among the evaluated biomarkers.These findings should be interpreted cautiously, given the observational design and limited sample size, and should be validated in larger, multicenter cohorts.