Left Ventricular Dysfunction and Plasmatic NT-proBNP Are Associated with Adverse Evolution in Respiratory Syncytial Virus Bronchiolitis
Left Ventricular Dysfunction and Plasmatic NT-proBNP Are Associated with Adverse Evolution in Respiratory Syncytial Virus Bronchiolitis
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DOI：
10.3390/diagnostics9030085
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发表时间：
2019-07
期刊：
影响因子：
3.6
通讯作者：
M. Rodríguez-González;A. A. Perez-Reviriego-A.;Ana Castellano-Martínez;S. Lubián-López;Isabel Benavente-Fernández
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文献类型：
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作者：
M. Rodríguez-González;A. A. Perez-Reviriego-A.;Ana Castellano-Martínez;S. Lubián-López;Isabel Benavente-Fernández
目的：探讨通过 Tei 指数 (LVTX) 评估的左心室心肌功能障碍 (LVMD) 的存在是否会影响患有呼吸道合胞病毒性细支气管炎 (RSVB) 的健康婴儿的预后。探讨 N 末端 B 型利钠肽原 (NT-proBNP) 是否可以提高传统临床标志物预测结果的准确性。方法：一项单中心、前瞻性队列研究，包括 2016 年 10 月 1 日至 2017 年 4 月 1 日因 RSVB 入院的 1-12 个月大健康婴儿。所有患者均在入院 24 小时内接受临床、实验室和超声心动图评估。儿科重症监护病房 (PICU) 入院被定义为严重疾病。结果：我们纳入了 50 名 RSVB 病例（中位年龄为 2 (1-6.5) 个月；40% 为女性）和 50 名年龄匹配的对照组。我们观察到 RSVB 婴儿的 LVTX 值高于对照组（0.42 vs. 0.36；p = 0.008）。多达 9 名 (18%) 儿童出现 LVMD (LVTX > 0.5)，入住 PICU 的发生率较高（89% vs. 5%；p < 0.001）。 NT-proBNP 在预测 LVMD 方面的诊断性能较高（受试者工作特征曲线下面积 (AUC) 0.95，CI 95% 0.90–1）。包含 NT-proBNP 的 PICU 入院预测模型的诊断率非常出色（AUC 0.945，CI 95% 0.880–1），并且显着高于不含 NT-proBNP 的模型（p = 0.026）。结论：患有 RSVB 并发展为严重疾病的健康婴儿可能存在 LVMD。 NT-proBNP 似乎可以改善传统的临床结果标志物。
Aim: To investigate whether the presence of left ventricular myocardial dysfunction (LVMD) assessed by Tei index (LVTX) impacts the outcomes of healthy infants with Respiratory Syncytial Virus Bronchiolitis (RSVB). To explore whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) increases the accuracy of traditional clinical markers in predicting the outcomes. Methods: A single-centre, prospective, cohort study including healthy infants aged 1–12 months old admitted for RSVB between 1 October 2016 and 1 April 2017. All patients underwent clinical, laboratory and echocardiographic evaluation within 24 h of admission. Paediatric intensive care unit (PICU) admission was defined as severe disease. Results: We enrolled 50 cases of RSVB (median age of 2 (1–6.5) months; 40% female) and 50 age-matched controls. We observed higher values of LVTX in infants with RSVB than in controls (0.42 vs. 0.36; p = 0.008). Up to nine (18%) children presented with LVMD (LVTX > 0.5), with a higher incidence of PICU admission (89% vs. 5%; p < 0.001). The diagnostic performance of NT-proBNP in predicting LVMD was high (area under the receiver operator characteristic curve (AUC) 0.95, CI 95% 0.90–1). The diagnostic yield of the predictive model for PICU admission that included NT-proBNP was excellent (AUC 0.945, CI 95% 0.880–1), and significantly higher than the model without NT-proBNP (p = 0.026). Conclusions: LVMD could be present in healthy infants with RSVB who develop severe disease. NT-proBNP seems to improve traditional clinical markers for outcomes.