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Christou E, Iliodromiti Z, Pouliakis A, Loukatou E, Varela P, Panagoulia A, Chasiakou A, Zisimopoulos S, Iacovidou N, Boutsikou T. Urinary NT-proBNP: A Useful Biomarker for the Diagnosis of Respiratory Distress in the Neonatal Population. Cureus 2023; 15:e39019. [PMID: 37323310 PMCID: PMC10266900 DOI: 10.7759/cureus.39019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To determine the diagnostic accuracy of urinary NT-proBNP levels in the detection and classification of the severity of respiratory distress in neonates after birth. METHODS We compared the urinary NT- proBNP levels between the respiratory distress (RD) group and the control group on the 1st, 3rd, and 5th day of life (DOL). RESULTS The RD group (55 neonates) showed higher levels of NT-proBNP compared to the control group (63 neonates) on DOL1 (585.4 pg/ml vs 396.1 pg/ml (p=0.014)), DOL3 (805.1 pg/ml vs 271.9 pg/ml (p<0.001)) and DOL5 (409.7 pg/ml vs 94.4 pg/ml (p<0.001)). Especially, on DOL5, the area under the ROC curve was 0.884 and the NT-proBNP cut-off value (221.8 pg/ml) showed a sensitivity of 71% and specificity of 79%. The RD group was subclassified into neonates with mild (21 neonates), moderate (19 neonates), and severe (15 neonates) disease. NT-proBNP cut-off point of 668 pg/ml for DOL5 can safely differentiate neonates with severe disease from those with mild and moderate disease (combined subgroups) since the sensitivity was 80% and specificity was 77.5% for DOL5. CONCLUSION Urinary NT-proBNP levels are a useful biomarker in detecting clinical signs of respiratory distress in neonates that are born within the first week of life; they can also detect neonates that are vulnerable to severe forms of the disease.
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Affiliation(s)
- Evangelos Christou
- Department of Pediatrics, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, GRC
- Department of Neonatology, Aretaieion University Hospital, Athens, GRC
| | - Zoi Iliodromiti
- Department of Neonatology, Aretaieion University Hospital, Athens, GRC
| | - Abraham Pouliakis
- Epidemiology and Public Health, 2nd Department of Pathology, National and Kapodistrian University of Athens, Athens, GRC
| | - Eirini Loukatou
- Department of Pediatrics, Alexandra General Hospital, Athens, GRC
| | - Pinelopi Varela
- Department of Pediatrics, Alexandra General Hospital, Athens, GRC
| | - Adamantia Panagoulia
- Department of Biochemistry, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, GRC
| | - Anthia Chasiakou
- Department of Biopathology, Aretaieion University Hospital, Athens, GRC
| | - Spyridon Zisimopoulos
- Department of Pediatrics, Elena Venizelou General and Maternity Hospital, Athens, GRC
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Khalid K, Padda J, Komissarov A, Colaco LB, Padda S, Khan AS, Campos VM, Jean-Charles G. The Coexistence of Chronic Obstructive Pulmonary Disease and Heart Failure. Cureus 2021; 13:e17387. [PMID: 34584797 PMCID: PMC8457262 DOI: 10.7759/cureus.17387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/21/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic illness that is widely prevalent within the United States and has been frequently associated with heart failure (HF). COPD is associated with progressive damage and inflammation of the airways leading to airflow obstruction and inadequate gas exchange. HF represents a decline in the normal functioning of the heart resulting in insufficient pumping of blood through the circulatory system. COPD and HF present with similar signs and symptoms with some variation. There are many specific diagnostic tests and treatment modalities which we use to diagnose COPD and HF, but it becomes an issue when you come across a patient who has both conditions simultaneously. For example, attempting to use an X-ray to diagnose HF in a COPD patient is next to impossible because the results are manipulated by the COPD disease process. This is the case with many other diagnostic tests such as an electrocardiogram (ECG), chest radiography (X-ray), B-type natriuretic peptide (BNP), echocardiogram, cardiac magnetic resonance imaging (CMR), pulmonary function test (PFT), arterial blood gas (ABG), and exercise stress testing. When a patient has both COPD and HF, it becomes more difficult to treat. Many treatments for HF have negative impacts on COPD patients and vice-versa, whereas some have also shown positive clinical outcomes in both diseases. It is agreeable that treatment has to be patient-centered and it can vary from case to case depending on the severity of the disease. Ultimately, in this review, we discuss COPD and HF and how they interplay in their diagnostic and treatment modalities to gain a better understanding of how to effectively manage patients who have been diagnosed with both conditions.
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Affiliation(s)
- Khizer Khalid
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Jaskamal Padda
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA.,Internal Medicine, Avalon University School of Medicine, Willemstad, CUW
| | - Anton Komissarov
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Lanson B Colaco
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Sandeep Padda
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA.,Internal Medicine, Avalon University School of Medicine, Willemstad, CUW
| | - Armughan S Khan
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | | | - Gutteridge Jean-Charles
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA.,Internal Medicine, Advent Health & Orlando Health Hospital, Orlando, USA
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Otaal PS, Pachipala S, Uppal L, Bootla D. Correlation of Vitamin D Deficiency With Severity of Chronic Heart Failure as Assessed by Functional Class and N-Terminal Pro-Brain Natriuretic Peptide Levels. Cureus 2021; 13:e13522. [PMID: 33786229 PMCID: PMC7996472 DOI: 10.7759/cureus.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Chronic heart failure (CHF) is a major cause of mortality and morbidity in spite of tremendous advances in medical therapies. Vitamin D deficiency has been increasingly recognised in heart failure and its therapeutic as well as prognostic implications are debated. This study was carried out to examine the relationship of Vitamin D levels with severity of heart failure as assessed by NYHA functional class and serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels in vitamin D deficient patients with CHF. Methodology and results In this cross-sectional analysis, 119 patients of symptomatic CHF presenting to the outpatient/inpatient department of cardiology in a tertiary care institute in North India were screened. Patients were categorised according to their functional class as New York Heart Association (NYHA) class II, III, IV and their serum levels of vitamin D and NT-pro-BNP were measured. Out of 119 patients, 107 (90%) were found to have low vitamin D levels which were classified as insufficient (20-30 ng/ml) (n=25, 23%) or deficient (<20 ng/ml) (n=82,77%). The mean NT-pro-BNP levels increased significantly across functional class as 3783±6132 pg/ml, 7866±4383 pg/ml, 21115±11905 pg/ml in NYHA class II, III and IV respectively (p=0.000). The respective mean serum Vitamin D3 levels of 11.6±5.8ng/ml, 12.2±7.9 ng/ml, 14.4±8.9 ng/ml were not significantly different between classes (p=0.234). We found no correlation between serum NT-pro-BNP and serum vitamin D levels in the study cohort across various NYHA classes. In multivariate regression model, after adjusting for various co-variates, vitamin D levels were not significantly associated with NT-pro-BNP or functional class in patients with CHF. Conclusion Patients with CHF have a high prevalence (90%) of vitamin D deficiency. Although NT-pro-BNP levels increase significantly, vitamin D levels do not vary significantly with worsening NYHA classes. Further, no consistent significant correlation of vitamin D deficiency with NT-pro-BNP across different NYHA classes was observed. Thus, low levels of vitamin D didn't predict the severity and prognosis of patients with heart failure. .
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Affiliation(s)
- Parminder S Otaal
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sudheer Pachipala
- Department of Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Lipi Uppal
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Dinakar Bootla
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
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Li J, Ning B, Wang Y, Li B, Qian J, Ren H, Zhang J, Hu X. The prognostic value of left ventricular systolic function and cardiac biomarkers in pediatric severe sepsis. Medicine (Baltimore) 2019; 98:e15070. [PMID: 30921240 PMCID: PMC6456134 DOI: 10.1097/md.0000000000015070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Echocardiography and cardiac biomarkers, such as cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) are useful tools to evaluate cardiac dysfunction. Left ventricular systolic dysfunction (LVSD) is common in pediatric severe sepsis. The aim of this study is to evaluate the prognostic value of LVSD, cTnI, and NT-pro BNP for pediatric severe sepsis.A prospective, single center, observational study was conducted. Severe sepsis children were enrolled in the study from December 2015 to December 2016 in pediatric intensive care unit of Shanghai Children's Medical Center. Recorded general information, transthoracic echocardiography were performed at day 1, 2, 3, 7, and 10, using Simpson to measure left ventricular end-diastolic dimension and left ventricular end-systolic dimension, obtained echocardiography parameters: left ventricular ejection fraction (LVEF), left ventricular fractional shortening, left ventricular end-diastolic volume, left ventricular end- systolic volume, stroke volume, cardiac output. At the same time collecting the blood sample to measure cTnI, NT-pro BNP. The definition of LVSD was LVEF <50%. According to the prognosis of 28 days, children with severe sepsis were divided into survived group and nonsurvived group.Total of 50 pediatric patients who were diagnosed with severe sepsis (including septic shock) were enrolled, the incidence of LVSD was 52%. The 28-day mortality rate of severe sepsis was 34%. Multivariate logistic regression analyses for predictors of death in pediatric severe sepsis revealed that the 28-day mortality of severe sepsis was associated with mechanical ventilation (MV) within the first 6 hours of admission (odds ratio [OR], 0.01; 95% confidence interval [CI], 0.00-0.07) and total MV time (OR, 0.81; 95% CI, 0.68-0.97). The receiver operating characteristic curves LVEF (area under curve = 0.526), cTnI (area under curve = 0.480), and NT-pro BNP (area under curve = 0.624) were used to predict the 28-day mortality in pediatric severe sepsis. Follow-up echocardiography parameters for survived group and nonsurvived group showed no significant changes in LVEF, LVFS, stroke volume index, cardiac index (CI), left ventricular end-diastolic volume index and left ventricular end-systolic volume index at day 1, 2, 3, 7, and 10, except for CI at day 1 and 2. Kaplan-Meier plot of 28-day mortality and LVSD in pediatric severe sepsis showed there were no statistical differences (χ = 0.042, P = .837).LVSD occurs frequently in pediatric with severe sepsis. The 28-day mortality rate of severe sepsis was also high. In this study, none of LVSD, cTnI, and NT-proBNP was associated with the prognosis of pediatric severe sepsis.
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Zapolski T, Wysokiński A, Książek A, Jaroszyński A. Left atrial volume index and aortic stiffness index in adult hemodialysed patients--link between compliance and pressure mediated by endothelium dysfunction; a cross-sectional study. BMC Cardiovasc Disord 2012; 12:100. [PMID: 23122326 PMCID: PMC3519803 DOI: 10.1186/1471-2261-12-100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 10/19/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND This study was performed to investigate the relationship between elastic properties of aorta and left atrium volume index (LAVI) in hemodialyzed (HD) patients. METHODS Study group was consisted of 73 patients (age 51,6 ± 7,6 years) treated by hemodialysis. In all patients standard echocardiography was performed. Aortic stiffness index (ASI) was calculated using formula: ASI = log (SBP/DBP)/[(Aomax-Aomin)/Aomin]. LAVI was calculated according to the formula: LAVI = [π/6 x (LAmax x LAshort x LAlong)]/m(2). Additionally several indices were calculated: left ventricle mass (LVM), left ventricle mass index (LVMI), midwall fractional shortening (mFS), endsystolic stress (ESS), mFS/ESS. Additionally the laboratory parameters including lipidogram, troponin T (cTnT), NT-proBNP and asymmetric dimethylarginine (ADMA) were measured. RESULTS The ASI was strong and significantly correlated with left atrium volume (LAV) and LAVI (respectively: 0,601; p < 0,001 and 0,598; p < 0,001). The ASI was independently and markedly associated with ADMA, cTnT, CRP, T-chol, and LDL-chol. The LAVI was independently and significantly correlated with NT-proBNP and cTnT. CONCLUSIONS There is correlation between ASI and ADMA, marker of endothelium dysfunction. There is also association between LAVI and NT-proBNP, signs of elevated left atrium pressure. The strong correlation between ASI and LAVI, improved by associations of specific biochemical markers with these echocardiographic indices, suggests there is the link between elastic properties of aorta and left atrium pressure in hemodialysed patients mediated by endothelial dysfunction.
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Affiliation(s)
- Tomasz Zapolski
- Chair and Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Andrzej Wysokiński
- Chair and Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Andrzej Książek
- Chair and Department of Nephrology, Medical University of Lublin, Lublin, Poland
| | - Andrzej Jaroszyński
- Chair and Department of Family Medicine, Medical University of Lublin, Lublin, Poland
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