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UTILITY VALUE OF PLASMA LEVELS OF N-TERMINAL PRO-B TYPE NATRIURETIC PEPTIDE IN THE ASSESSMENT OF CARDIAC DYSFUNCTION IN CHILDREN WITH PROTEIN ENERGY MALNUTRITION ATTENDING LAGOS UNIVERSITY TEACHING HOSPITAL
Abstract
This cross-sectional hospital based study was carried out to examine the utility of
plasma levels of NT- proBNP and correlate levels with cardiac dysfunction in children
with PEM. It lasted for six months, from January to June 2015, during which 70
children aged six to 60 months diagnosed with moderate and severe forms of PEM,
and 70 age and sex- matched well nourished controls had their plasma levels of NT
proBNP measured and compared. Plasma levels of NT-proBNP were correlated with
echocardiography parameters of left ventricular dysfunction (systolic and diastolic),
also the relationships between plasma NT-proBNP and age, gender, Ross score,
haemoglobin levels and serum electrolytes (calcium, potassium and sodium,) were
determined.
The median and interquartile levels of plasma NT-proBNP in malnourished children
were 350.8pg/ml (42.5-5560.6pg/ml) respectively, compared with 1061.7pg/ml
(176.8-2387.1pg/ml) in the controls. This difference was not statistically significant.
Thirty-eight (54.3%) of malnourished children had echocardiographic evidence of left
ventricular dysfunction, of whom 26 (68.4%) had only LV diastolic dysfunction, while
9 (23.7%) and 3 (7.9%), had systolic dysfunction alone and combined systolic and
diastolic dysfunction respectively. Twenty-three (32.9%) of the malnourished children
had moderate malnutrition, while forty-seven (67.1%) were severely malnourished.
Two indices of LV systolic function (ejection fraction and fractional shortening) were
significantly lower 61.92±6.71 and 31.70±5.82 in the severely malnourished children,
when compared with 67.22±6.64 and 35.78±5.10 in the children with moderate
malnutrition (p= 0.003 and p=004). Similarly, the two indices of diastolic dysfunction
(E/A and E/E’) were also lower, in severe malnutrition compared with moderate
malnutrition. Malnourished children who had LV diastolic dysfunction alone or
combined LV systolic and diastolic dysfunctions had higher median levels of plasma
NT-proBNP than those with only LV systolic dysfunction. At a cut off value of
322.9pg/ml, NT-proBNP identified LV dysfunction with sensitivity, specificity, positive
and negative predictive values of 55.3%, 56.3%, 60% and 51.4% respectively.
There was a weak but significant correlation between sodium and plasma NT
proBNP (rs= -0.236; p= 0.049), but no correlation with other measured variables
(age, gender, calcium, potassium, albumin and hemoglobin). The three (4.3%) in
hospital mortalities observed during this study were associated with severe
malnutrition and very low levels of NT-proBNP ranging from 8 to 267.5pg/ml. The
findings of this study show that although children with PEM have echocardiography
evidence of both systolic and diastolic dysfunction, their levels of plasma NT-proBNP
were not elevated when compared with well-nourished controls, suggesting that the
utility of NT-proBNP alone in determining PEM-linked cardiac dysfunction may be
limited.
