natriuretic-peptide--brain and Bronchiolitis

Bronchiolitis is a common viral illness which can lead to severe respiratory compromise and can coexist with or mask cardiac failure. Brain natriuretic peptide (BNP) and the inactive portion of its pro-hormone: N-terminal pro-BNP (NT-proBNP) are excreted in response to cardiomyocyte stretching and are established biomarkers in cardiac failure. Here, we discuss the technicalities of NT-proBNP testing and review available evidence regarding NT-proBNP testing in bronchiolitis. We identified and appraised seven studies assessing the role of BNP or NT-proBNP as biomarkers of bronchiolitis severity, in children with and without underlying congenital cardiac disease. One study of 76 children with dyspnoea showed that the median NT-proBNP level in children with cardiac failure was 7321 pg/mL vs 241 pg/mL in children with a respiratory cause of dyspnoea vs 87.21 pg/mL in healthy controls (p<0.05). A cut-off of 726 pg/mL could aid differentiation between cardiac and respiratory causes of respiratory distress. Other evidence showed a positive correlation between BNP levels and bronchiolitis severity, and that raised BNP can predict acute heart failure in children with congenital cardiac disease presenting with bronchiolitis. However, most studies consisted of small cohorts with conflicting evidence between them. Furthermore, several studies assessed BNP rather than NT-proBNP directly. BNP has a shorter half-life, which may affect analysis. In conclusion, NT-proBNP is a rapid and inexpensive test with the potential to be a useful biomarker in severe bronchiolitis and cases complicated by acute cardiac failure. However, studies with larger cohorts are required to better establish this role.

Topics: Biomarkers; Bronchiolitis; Child; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Severity of Illness Index

Extrapulmonary manifestations of bronchiolitis have been previously studied, with some identifying right ventricle (RV) diastolic/systolic dysfunction. We hypothesized that severe cases of bronchiolitis would have cardiac dysfunction resulting an increase in N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) values and worse outcomes. Therefore, the objective was to evaluate the existence of cardiac dysfunction and to determine its association with severe bronchiolitis.. This prospective cohort study included children hospitalized for bronchiolitis under 1-year old between January 2019 and March 2020. At admission, an echocardiography was performed and plasma levels of NT-proBNP were measured. To analyze outcomes, the cohort was divided into two groups based on the need for positive pressure respiratory support (PPRS), and both were compared to healthy infants.. bivariant analysis, significant differences p < 0.05.. One hundred eighty-one patients were included; median age was 2 months. Seventy-three patients required PPRS. Compared to controls, patients requiring PPRS showed worse RV systolic function, with lower tricuspid annular-plane systolic excursion (p = 0.002) and parameters of worse right and left diastolic function (trans-tricuspid E and A wave [p = 0.004 and p = 0.04, respectively] and tricuspid tissue doppler imaging [TDI] e' [p = 0.003], trans-mitral E and mitral TDI a' [p = 0.02 and p = 0.005, respectively]). An NT-ProBNP greater than 3582 pg/dl predicts the need for longer necessity of PPRS in patients younger than 2 months.. In addition to the expected RV systolic dysfunction, patients with severe bronchiolitis have parameters of global diastolic worse function possibly secondary to intrinsic myocardial involvement. NT-ProBNP values at admission had strong discriminatory power to predict worse outcomes.

Topics: Biomarkers; Bronchiolitis; Diastole; Heart Diseases; Heart Ventricles; Humans; Infant; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies

We aimed to analyze the correlation of urinary with serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations and its association with severity in acute bronchiolitis.. A pilot observational study was conducted between October 1, 2021 and March 31, 2022 including acute bronchiolitis cases who attended our institution. Serum and urinary NT-proBNP concentrations were determined using the Alere i NT-proBNP assay in time-matched urine and blood samples. The Mann-Whitney U test, Spearman's correlations, and simple linear regression were utilized to analyze the association of urine NT-proBNP levels with serum NT-proBNP and with variables indicative of severe bronchiolitis.. The urinary NT-proBNP concentrations could be a reliable surrogate for serum NT-proBNP levels and resulted elevated in cases of acute bronchiolitis with complicated evolution, suggesting a potential as a noninvasive tool to assess severity in this setting.

Topics: Biomarkers; Bronchiolitis; Humans; Infant; Natriuretic Peptide, Brain; Peptide Fragments; Pilot Projects

Pulmonary hypertension has been reported as a crucial factor in the pathophysiology of severe bronchiolitis. The aim of this study was to evaluate pulmonary artery pressure (PAP) in patients with bronchiolitis and to analyze their correlation with clinical outcomes. This prospective cohort study examined children admitted for bronchiolitis. PAP was assessed by right ventricle (RV) acceleration/ejection time ratio (AT/ET), isovolumic relaxation time, eccentricity index, and the presence of a pulmonary systolic notch. Pulmonary hypertension (PH) was considered if at least two altered parameters were present. Severity of clinical course was established by higher N-terminal (NT)-prohormone BNP (NT-proBNP) values, the need for positive pressure respiratory support (PPRS), and the duration of hospital admission. One hundred sixty-nine children were included in analysis. Sixty-eight patients (40%) required PPRS, and those patients had increased NT-proBNP values and worse tricuspid annular systolic excursion (TAPSE) compared to mild cases (p < 0.001and p < 0.001, respectively). Twenty-two (13%) cases had at least two altered parameters of PAP and met criteria for presumed PH, with no differences in NT-proBNP values, TAPSE, need for PPRS or hospital length of stay compared to normal PAP group (p = 0.98, p = 0.07, p = 0.94 and p = 0.64, respectively). We found no correlation between altered RV AT/ET and worse cardiac function, NT-proBNP values or hospital length of stay. In our cohort, the presence of echocardiographic findings of PH were not associated with worse clinical outcomes. Patients with severe bronchiolitis had higher values ​​of NT-proBNP but, interestingly, no clear association with PH.

Topics: Biomarkers; Bronchiolitis; Child; Echocardiography; Humans; Hypertension, Pulmonary; Infant; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies

We aimed to explore and to compare the association between the NT-proBNP and high-sensitivity troponin I (hs-cTnI) at early stages of acute bronchiolitis with echocardiographic alterations, clinical severity and outcomes.. A single centre, prospective observational study including previously healthy infants aged 1-12 months with bronchiolitis admitted to a tertiary hospital from April 2019 to March 2020. All patients underwent clinical, laboratory and echocardiographic evaluation at the same time point within 12 h of hospital admission. NT-proBNP > 1121 pg/ml and hs-cTnI > 26 ng/L were considered elevated. The primary outcome measure was the association of raised cardiac biomarkers with the need for PICU admission.. We enrolled 40 infants with median levels of NT-proBNP of 1176 (520-3030) pg/ml and hs-cTnI of 11.5 (5-21) ng/L at the time of hospital admission. Raised levels of NT-proBNP and hs-cTnI in 50% and 20% of cases, respectively. Of them, 15 (37%) required PICU admission during the hospitalization. Increased NT-proBNP was associated with PICU admission (adjusted OR 9.5 (CI95% 1.4-64); p = 0.020), prolonged hospitalization (β = 2.7; p = 0.012) and duration of oxygen administration (β = 2.7; p = 0.004) in the multivariate analysis. There were no differences in hs-cTnI levels regarding PICU admission (p = 0.866). Increased hs-cTnI levels were only associated with oxygen administration duration (Spearman rho = 0.38; p = 0.017), but this association disappeared in the multivariate analysis. Only NT-proBNP was associated with echocardiographic parameters of myocardial dysfunction (p < 0.001), and pulmonary hypertension (p < 0.001) CONCLUSION: Early elevated NT-proBNP but not hs-cTnI could be used as a biomarker for myocardial strain and disease severity in bronchiolitis.

Topics: Biomarkers; Bronchiolitis; Humans; Infant; Natriuretic Peptide, Brain; Peptide Fragments; Troponin I

Acute bronchiolitis, usually caused by the respiratory syncytial virus, is the most common cause of severe respiratory distress in infants. The clinical relevance of cardiac biomarkers for diagnosis and prognosis of bronchiolitis in infants is still controversial.. This Editorial discuss the results of a recent on the clinical relevance of cardiac specific biomarkers, NT-proBNP and cardiac troponin I (cTnI) in 40 infants with bronchiolitis, 37% requiring admission in the ICU.. NT-proBNP levels were significantly associated with prolonged hospitalization and duration of oxygen therapy, while cTnI levels, measured with high-sensitivity (hs) methods, did not. Furthermore NT-proBNP was significantly correlated with left and right ventricular functional echocardiographic parameters, while hs-cTnI was not associated with any echocardiographic parameter.. Recent results confirm that NT-proBNP assay has a crucial role in the diagnosis, prognosis and follow-up of patients with cardiac disease not only in adult, but even in pediatric age). On the other hand, the clinical usefulness of assay of hs-cTnI and hs-cTnT in pediatric cardiology, at present time, may be greatly limited by the lack of reliable reference intervals.. Further well-designed multi-center studies are needed to more accurately evaluate the clinical relevance of cardio-specific biomarkers, and in particular of hs-cTnI and hs-cTnT assay, on prognosis of infants with bronchiolitis.

Topics: Biomarkers; Bronchiolitis; Humans; Infant; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Troponin I; Troponin T

The aim of the study was to determine whether the B-type natriuretic peptide (BNP) plasma level predicted the severity of bronchiolitis without additional pathology in children admitted to an emergency department (ED). A total of 232 children (mean age: 7.7±1.2 months [range: 1-23 months]) presenting to ED with isolated bronchiolitis and 32 age- and gender-matched control subjects were included in the study. BNP levels differed significantly among the control (8.5±1.1 pg/ml) and mild (27.7±2.6 pg/ml), moderate (51.4±0.5 pg/ml), and severe (106.8±4.8 pg/ml) bronchiolitis groups (p < 0.001). Clinical severity score (p < 0.001; OR: 2.524; 95% CI: 1.826-3.487) and plasma BNP level (p < 0.001; OR: 2.231; 95% CI: 1.583-3.242) were independent risk factors for hospitalization. The length of hospital stay was significantly correlated with BNP level (p < 0.001; r: 0.698). In conclusion, the plasma BNP level may be a potent biomarker predicting disease severity in ED.

Topics: Biomarkers; Bronchiolitis; Child, Preschool; Emergency Service, Hospital; Female; Hospitalization; Humans; Infant; Length of Stay; Male; Natriuretic Peptide, Brain; Prospective Studies; Risk Factors; Severity of Illness Index

The aim of this study was to determine whether plasma levels of amino-terminal brain natriuretic peptide (BNP) could differentiate between heart failure and lung disease among infants with acute bronchiolitis.. Sixty-eight infants (age range, 1-26 months; median age, 5.9 ± 5.0 months) who presented with respiratory distress underwent physical examination, plasma BNP measurement, and echocardiography within 24 hours after admission. Nineteen (28%) patients had congenital heart disease. The control group was consisted of 30 healthy infants.. Although mean plasma BNP levels were 118.9 ± 219.5 pg/mL in patients with isolated bronchiolitis (n = 49), it was 841.2 ± 1475.8 pg/mL in patients with congenital heart disease (n = 19). Plasma BNP levels were significantly higher in infants with congenital heart disease (P = .001).. It was shown that plasma BNP levels were affected much more in cardiac disease rather than lung disease. Among infants with respiratory distress, plasma BNP measurements can differentiate congenital heart disease and lung disease and can be used to monitor the effects of treatment for infants with heart failure.. The comments were taken for consideration. The patient groups control BNP levels were attached to the results. As it was a clinical study and multiple factors (respiratory score, respiratory rate, treatment, etc) may effect on BNP levels, the tables could not be decreased to 1 table.

Topics: Acute Disease; Biomarkers; Bronchiolitis; Case-Control Studies; Child, Preschool; Echocardiography; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Natriuretic Peptide, Brain; Oxygen; Respiratory Insufficiency; Respiratory Rate

Topics: Bronchiolitis; Female; Heart Defects, Congenital; Humans; Male; Natriuretic Peptide, Brain; Respiratory Insufficiency