On-admission plasma levels of BNP, MR-proADM, and cTnI in pediatric heart failure: contributions to diagnosis, prognosis, and outcome

Salem, Sherif S.; Saleh, Nagwan Y.; Soliman, Shimaa E.; Abo‐Haded, Hany M.

doi:10.1007/s11845-021-02533-2

Cited by 4 publications

(6 citation statements)

References 29 publications

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“…Hypertension ( 27 ), heart failure ( 28 ), and renal failure ( 27 ) are associated with increased adrenomedullin levels in adults, with evidence of increased MR-proADM expression in pediatric heart failure ( 29 ). In our study, however, there was no significant difference in mean MR-proADM between patient subgroups with preexisting renal, cardiac, and endocrine comorbidities and those without.…”

Section: Discussionmentioning

confidence: 99%

Mid-Regional Pro-Adrenomedullin in Combination With Pediatric Early Warning Scores for Risk Stratification of Febrile Children Presenting to the Emergency Department: Secondary Analysis of a Nonprespecified United Kingdom Cohort Study*

Lenihan

Ang

Pallmann³

et al. 2022

Pediatric Critical Care Medicine

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OBJECTIVES: Current sepsis guidelines do not provide good risk stratification of subgroups in whom prompt IV antibiotics and fluid resuscitation might of benefit. We evaluated the utility of mid-regional pro-adrenomedullin (MR-proADM) in identification of patient subgroups at risk of requiring PICU or high-dependency unit (HDU) admission or fluid resuscitation. DESIGN: Secondary, nonprespecified analysis of prospectively collected dataset. SETTING: Pediatric Emergency Department in a United Kingdom tertiary center. PATIENTS: Children less than 16 years old presenting with fever and clinical indication for venous blood sampling ( n = 1,183). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome measures were PICU/HDU admission or administration of fluid resuscitation, with a secondary outcome of definite or probable bacterial infection. Biomarkers were measured on stored plasma samples and children phenotyped into bacterial and viral groups using a previously published algorithm. Of the 1,183 cases, 146 children (12.3%) required fluids, 48 (4.1%) were admitted to the PICU/HDU, and 244 (20.6%) had definite or probable bacterial infection. Area under the receiver operating characteristic (AUC) was used to assess performance. MR-proADM better predicted fluid resuscitation (AUC, 0.73; 95% CI, 0.67–0.78), than both procalcitonin (AUC, 0.65; 95% CI, 0.59–0.71) and Pediatric Early Warning Score (PEWS: AUC, 0.62; 95% CI, 0.56–0.67). PEWS alone showed good accuracy for PICU/HDU admission 0.83 (0.78–0.89). Patient subgroups with high MR-proADM (≥ 0.7 nmol/L) and high procalcitonin (≥ 0.5 ng/mL) had increased association with PICU/HDU admission, fluid resuscitation, and bacterial infection compared with subgroups with low MR-proADM (< 0.7 nmol/L). For children with procalcitonin less than 0.5 ng/mL, high MR-proADM improved stratification for fluid resuscitation only. CONCLUSIONS: High MR-proADM and high procalcitonin were associated with increased likelihood of subsequent disease progression. Incorporating MR-proADM into clinical risk stratification may be useful in clinician decision-making regarding initiation of IV antibiotics, fluid resuscitation, and escalation to PICU/HDU admission.

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Section: Discussionmentioning

confidence: 99%

Mid-Regional Pro-Adrenomedullin in Combination With Pediatric Early Warning Scores for Risk Stratification of Febrile Children Presenting to the Emergency Department: Secondary Analysis of a Nonprespecified United Kingdom Cohort Study*

Lenihan

Ang

Pallmann³

et al. 2022

Pediatric Critical Care Medicine

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“…61 Studies of children with heart failure secondary to biventricular physiology have found a correlation between troponin levels and clinical and/or echocardiogram evidence of heart failure, yet when compared to BNP, troponin remains diagnostically and prognostically inferior. 25,62 A small study of single ventricle patients which compared those with clinical evidence of heart failure to those without found that cTnI was unable to distinguish clinical heart failure in this cohort. 31…”

Section: Troponinmentioning

confidence: 99%

“…Salem et al, in their paper published in 2021, suggested on-admission brain naturetic peptide at a cut-of-point 507.13 pg/ml has 95.5% sensitivity and 88% specificity for in-hospital mortality. 25 Despite lack of assay cut-off values in congenital cardiac disease, this suggests brain naturetic peptide/NT-proBNP may be utilised as a prognostic indicator in known cardiac disease to aid earlier identification of patients most at risk of adverse outcomes.…”

Section: Brain Naturetic Peptide and Nt-probnpmentioning

confidence: 99%

Paediatric heart failure – understanding the pathophysiology and the current role of cardiac biomarkers in clinical practice

et al. 2023

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Introduction: Paediatric heart failure is a common clinical syndrome that may be experienced by children with congenital heart disease (CHD) and/or cardiomyopathy. It is characterised by clinical signs/symptoms which reflect the underlying pathophysiology based on one of three main clinical states: Pulmonary over-circulation, pressure overload, and ventricular failure. Current diagnosis relies on clinical assessment and echocardiogram imaging as cardiac biomarkers has been predominantly scientific to date. This review provides a comprehensive overview of paediatric heart failure pathophysiology and considers the available evidence for cardiac biomarkers in this setting. Methods: A literature review was completed using MEDLINE ALL, EMBASE, and PubMed on 10th November, 2022. Search terms included biomarkers, heart failure, heart defects, congenital heart disease, fontan circulation, single ventricle circulation, cardiomyopathy, and child. This allowed the identification of individual cardiac biomarkers which are the focus of this review. These included NT-proBNP, MR-proANP, MR-proADM, troponin, sST2, galectin 3, and growth differentiation factor-15. Results: Paediatric studies have established reference ranges for NT-proBNP and troponin for children with structurally normal hearts. Of all the biomarkers reviewed, NT-proBNP appears to correlate most closely with symptoms of heart failure and ventricular dysfunction on echocardiogram. However, there remains limited longitudinal data for NT-proBNP, and no validated reference ranges for patients with CHD and/or cardiomyopathy. None of the other biomarkers reviewed were consistently superior to NT-proBNP. Conclusion: Further large paediatric studies of patients with heart failure are needed to validate NT-proBNP in CHD and to evaluate the role of novel biomarkers in specific types of CHD, e.g. single ventricle physiology.

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“…For instance, the mild-regional proadrenomedullin which is a neuro-hormone responsive to myocardial stretch similar to BNP, was evaluated on admission in children (average age 24 months) presenting with HF. The study reported a high diagnostic value of plasma BNP, MR-proADM, and Troponin-I levels as a triple-panel upon admission showing a correlation between the clinical severity and disease progression of pediatric HF ( 76 ). Furthermore, Galactin-3 which is a carbohydrate-binding lectin that is released by macrophages to regulate inflammatory functions in immunity, and cancer, has been proposed as a suitable tool for the diagnosis and risk stratification of chronic HF in children ( 40 ), however it has not yet been established as in adult HF.…”

Section: Omics Studies For Biomarker Discovery In Chdmentioning

confidence: 99%

Insights and perspectives into clinical biomarker discovery in pediatric heart failure and congenital heart disease—a narrative review

Liem¹,

Cadeiras²,

Setty³

2023

Cardiovasc Diagn Ther

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Background and Objective: Heart failure (HF) in the pediatric population is a multi-factorial process with a wide spectrum of etiologies and clinical manifestations, that are distinct from the adult HF population, with congenital heart disease (CHD) as the most common cause. CHD has high morbidity/mortality with nearly 60% developing HF during the first 12 months of life. Hence, early discovery and diagnosis of CHD in neonates is pivotal. Plasma B-type natriuretic peptide (BNP) is an increasingly popular clinical marker in pediatric HF, however, in contrast to adult HF, it is not yet included in pediatric HF guidelines and there is no standardized reference cut-off value. We explore the current trends and prospects of biomarkers in pediatric HF, including CHD that can aid in diagnosis and management.Methods: As a narrative review, we will analyze biomarkers with respect to diagnosis and monitoring in specific anatomical types of CHD in the pediatric population considering all English PubMed publications till June 2022.

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On-admission plasma levels of BNP, MR-proADM, and cTnI in pediatric heart failure: contributions to diagnosis, prognosis, and outcome

Cited by 4 publications

References 29 publications

Mid-Regional Pro-Adrenomedullin in Combination With Pediatric Early Warning Scores for Risk Stratification of Febrile Children Presenting to the Emergency Department: Secondary Analysis of a Nonprespecified United Kingdom Cohort Study*

Mid-Regional Pro-Adrenomedullin in Combination With Pediatric Early Warning Scores for Risk Stratification of Febrile Children Presenting to the Emergency Department: Secondary Analysis of a Nonprespecified United Kingdom Cohort Study*

Paediatric heart failure – understanding the pathophysiology and the current role of cardiac biomarkers in clinical practice

Insights and perspectives into clinical biomarker discovery in pediatric heart failure and congenital heart disease—a narrative review

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