Diagnostic Accuracy of Brain Natriuretic Peptide in Neonates with different CHD.

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Eugene Davidson
5 years ago
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1 Diagnostic Accuracy of Brain Natriuretic Peptide in Neonates with different CHD. Cantinotti M, Arcieri L, Margaryan R, Maizza A, Storti S, Luisi S, Bernabei M, Crocetti M, Assanta N, Murzi B. G Monasterio Foundation and Institute of Clinical Physiology-National Research Council, G. Pasquinucci Hospital, Massa, Italy

2 Background The humoral behaviour of BNP in newborns and infants remains unclear. New fields of application have been recently proposed.

6 Background So far the clinical use of BNP in this group of age has been extremely controversial mainly for the lack of clear reference values. We reported for the first time in literature the reference values for BNP immunoassay assessed in a large population of newborns.

7 Cantinotti M et all. Reference values for plasma B-type B natriuretic peptide in the first days of life. Clin Chem 2009

8 BNP vs NT-proBNP 3971 samples

9 Aim of The Study To evaluate the diagnostic accuracy of BNP assay in children with CHD in the first month of life.

10 Materials and Methods BNP was measured in 233 neonates with untreated CHD. 154 controls, matched for age. BNP was measured by a fully automated platform (Triage-BNP reagents, Access Immunoassay Systems, Beckman Coulter, Inc.).

11 Materials and Methods CHD were divided into 5 major subgroups: LVVO (VSD, PDA, truncus, etc) 33 pts. LVPO (AoC, AS) 40 pts. RVPO (TF, PS, etc) 45 pts. TGA 60 pts. UH 55 pts.

12 Materials and Methods In pts undergoing surgical correction/palliation of CHD major complications and different operative and post-operative parameters (CEC time, ICU stay, intubation time, inotropic time) were collected. Statistical analysis was performed by ANOVA.

13 Results BNP values were significantly higher in CHD than controls (p<0.0001). CHD: mean ± ng/l, range ng/l. Controls: mean 189.4±174.4 ng/l, range ng/l.

14 Results The diagnostic accuracy of BNP was assessed by ROC analysis taking into account 3 groups of age. Group-1: all CHD patients and controls as a whole (1-30th days of life) (233 pts); Group-2: 1st-3rd days of life (85 pts); Group-3: 4th-30th days of life (148 pts).

15 Results The AUC of the ROC curve of Group 3 (0,935) significantly higher than Group 1 (0,843, p=0,009) and Group 2 (0,769, p=0,0003). The AUC of Group 1 and Group 2 were not significantly different (p=0,191)

16 Diagnostic accuracy of BNP in different groups of age. Groups AUC Sens Spec Cut-off values ng/l Group 1 ( day) Group 2 (1-3 day) Group 3 ( day) 0,843 0,73 0, ,769 0,866 0, ,935 0,80 0,91 206

17 Results There was a significant difference among groups of CHD (p=0,0275). The highest values were found in univentricular heart. RVPO patients showed lower BNP values than all the other groups.

18 BNP values in different CHD.

19 Correlations In pts undergoing surgical correction/palliation of CHD BNP values preoperatively were positively related to major complications (P<0,0006), ICU stay (P<0,03), intubation time (P<0,0024), inotropic time (P<0,0035) and inotropic score (P<0,0001).

20 Correlations of BNP values with parameters of outcome. BNP values Major complication Intubation time Hours in ICU Inotropic time Preop P 0,0006 P 0,0024 P 0,03 P 0,0035

21 Limitation of of the study The limited number of patients. To correctly interpretate BNP values: the need of age-related and CHD-related reference intervals.

22 Conclusions The accuracy of BNP in differentiating children with CHD from healthy subjects varies greatly during the first month of life, showing the lowest diagnostic accuracy in the first 3 days after birth. After the second week of life BNP becomes more accurate in the ruling in or out CHD.

23 Conclusions BNP values widely differ not only with age but also among various CHD with the highest values in UH and the lowest in RVPO. BNP may be considered a good prognostic marker in neonates with CHD undergoing surgical correction or palliation.

24 Diagnostic Accuracy of Brain Natriuretic Peptide in Neonates with different CHD. Cantinotti M, Arcieri L, Margaryan R, Maizza A, Storti S, Luisi S, Bernabei M, Crocetti M, Assanta N, Murzi B. G Monasterio Foundation and Institute of Clinical Physiology-National Research Council, G. Pasquinucci Hospital, Massa, Italy

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