Elevated High-Sensitivity Troponin and NT-proBNP Values in Febrile Children
Dorine M Borensztajn, Chantal D Tan1, Yolanda de Rijke2
1From the Department of General Pediatrics, Erasmus MC, Sophia Children's Hospital, Rotterdam, the Netherlands.
Insights
Elevated cardiac markers, high-sensitivity troponin (hs-TnT) and N-terminal probrain natriuretic peptide (NT-proBNP), are common in febrile children. These markers reflect disease severity, particularly in intensive care unit patients, rather than the specific fever cause.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Biomarker Research
Background:
- Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 has increased interest in cardiac biomarkers.
- High-sensitivity troponin (hs-TnT) and N-terminal probrain natriuretic peptide (NT-proBNP) are frequently elevated in MIS-C.
- Understanding these biomarkers in febrile children without COVID-19 is crucial.
Purpose of the Study:
- To investigate hs-TnT and NT-proBNP concentrations in febrile children unrelated to COVID-19.
- To compare biomarker levels between emergency department (ED) and pediatric intensive care unit (PICU) patients.
- To determine if biomarker levels correlate with the cause or severity of fever.
Main Methods:
- Retrospective analysis of leftover blood samples from febrile children (0-18 years).
- Inclusion of patients from ED and PICU settings within a multicenter prospective study (PERFORM).
- Measurement of hs-TnT and NT-proBNP, compared against control groups.
Main Results:
- Febrile children showed significantly higher hs-TnT and NT-proBNP levels than controls (P < 0.001).
- PICU patients exhibited markedly higher concentrations than ED patients (P < 0.001).
- Elevated levels were associated with comorbidities, critical illness, or multiorgan failure, not specific infection types (viral vs. bacterial).
Conclusions:
- hs-TnT and NT-proBNP are frequently elevated in febrile children across various underlying causes.
- Biomarker concentrations correlate with disease severity, with higher levels in PICU patients.
- These markers appear to indicate the severity of illness rather than the specific etiology of the fever.
Objectives:
The COVID-19 pandemic and subsequent rise of multisystem inflammatory syndrome in children have raised interest in high-sensitivity troponin (hs-TnT) and N-terminal probrain natriuretic peptide (NT-proBNP) because these have been found to be elevated in many cases of multisystem inflammatory syndrome in children. Our aim was to study hs-TnT and NT-proBNP concentrations in febrile children not affected by COVID-19.
Methods:
We retrospectively measured cardiac markers, hs-TnT, and NT-proBNP in leftover blood samples of febrile children (0-18 years) diagnosed and treated in a single-center emergency department (ED) (N = 67) and pediatric intensive care unit (PICU) (N = 19) that participated in a multicenter, prospective study of infection biomarkers (PERFORM).
Results:
Concentrations of hs-TnT, median 1.8 ng/L (interquartile range [IQR], 0.0-15.1), and NT-proBNP, 194 pg/mL (IQR, 54.9-706), were higher in febrile children than in controls (N = 25, hs-TnT 0.0 [IQR, 0-0]; NT-proBNP 56.3 [IQR, 29.7-109], both P < 0.001), whereas PICU patients had higher concentrations (hs-TnT 15.1 [IQR, 10.3-102] and NT-proBNP 828 [IQR, 657-4712], both P < 0.001) than ED patients (hs-TnT 0 [IQR, 0-7.4] and NT-proBNP 104 [IQR, 39.5-363]). No differences were found between viral and bacterial infections. Highest concentrations were found in children with either comorbidity predisposing to elevated concentrations (eg, chronic cardiac or renal disease) or children with critical illness or multiorgan failure such as those with septic shock.
Conclusions:
Concentrations of hs-TnT and NT-proBNP are often elevated in febrile children with different causes of fever. Concentrations were higher in children admitted to the PICU than in children attending the ED, and seem to reflect disease severity rather than the underlying cause of fever.
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