Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10435
Peer-review started: March 24, 2022
First decision: June 16, 2022
Revised: June 17, 2022
Accepted: September 1, 2022
Article in press: September 1, 2022
Published online: October 16, 2022
Multisystem inflammatory syndrome in children (MIS-C) has emerged as a new disease associated with COVID-19 that presents in acute critically ill children with acute cardiovascular dysfunction.
To determine whether the age-adjusted N-terminal pro-brain natriuretic peptide (NT-proBNP) value (Z-log-NT-proBNP) is associated with severe MIS-C and myocardial dysfunction.
A retrospective study was conducted which included children with MIS-C managed at our institution between April 1, 2020, and February 28, 2022. We divided the population into groups depending on severity based on pediatric intensive care unit (PICU) admission. We compared Z-log-NT-proBNP values across these groups and analyzed Z-log-NT-proBNP dynamics during the one-month follow-up.
We included 17 participants [median age 3 (2-9) years] and seven (41%) required PICU admission. All (100%) of these cases presented very high (Z-log > 4) levels of NT-proBNP at the time of admission compared to only 5 (50%) patients with non-severe MIS-C (P = 0.025). NT-proBNP was significantly correlated with high-sensitive Troponin I levels (P = 0.045), Ross modified score (P = 0.003) and left ventricle ejection fraction (P = 0.021).
Raised NT-proBNP, specifically very high values (Z-log-NT-proBNP > 4) could help in the early identification of MIS-C patients with myocardial dysfunction requiring inotropic support and PICU admission.
Core Tip: Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition associated with coronavirus disease 2019 in which the cardiovascular system is frequently impaired, with more than half of children presenting with heart failure and myocardial dysfunction secondary to the inflammatory response. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a promising biomarker for the detection of cardiac dysfunction in conditions where heart failure and inflammation coexist, but its use in pediatrics is limited by its strong age-dependency. Therefore, we think that the use of age-adjusted NT-proBNP values could help to identify those children with risk for severe MIS-C.