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NT-proBNP course during MIS-C post-COVID-19: an observational study

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Abstract

Multisystem inflammatory syndrome in children (MIS-C or PIMS-TS) is a severe disease. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is used for positive and differential diagnosis, diagnosis of complications and severity, and cardiogenic shock prediction. However, contrasting cut-offs have been suggested. The aims of the present study were to compare NT-proBNP values depending on the time of measurement and to describe the NT-proBNP course during the MIS-C episode. The data from a single-centre cohort observational study on the impact of time to diagnosis, defined as the time from first symptom to diagnosis of MIS-C, were used for the purpose of this study, with an extended period of inclusion from May 2020 to April 2023. The timing and level of all NT-proBNP samples available for each patient were retrospectively collected. Thirty-seven children (18 (49%) females, median age 8.8 years, 14 (38%) with shock) were included. Until diagnosis, NT-proBNP increased with time and was significantly higher at 6 days from first symptoms than at 3 days (median (interquartile range) 32,933 (7773–61,592) versus 1994 (1291–4190) pg/mL, respectively, p = 0.031). From diagnosis, NT-proBNP decreased by at least 50% after 3.0 (2.1–5.3) days (n = 12) when NT-proBNP at diagnosis was low ≤ 11,000 pg/mL versus 1.8 (0.7–3.4) days (n = 16) when NT-proBNP at diagnosis was high (p = 0.040), and after 3.6 (2.4–5.9) days (n = 7) when fever persisted after 48 h versus 1.8 (0.8–3.0) days (n = 21) when fever resolved before 48 h (p = 0.004).

  Conclusions: During the MIS-C episode, NT-proBNP increased over time until diagnosis and treatment. It dropped faster thereafter in children with high NT-proBNP at diagnosis > 11,000 pg/mL and slower in case of persistent fever.

What is Known:

• NT-proBNP is useful in MIS-C for positive and differential diagnosis, diagnosis of complications and severity, and cardiogenic shock prediction.

• Contrasting cut-offs for differential diagnosis and severity assessment have been suggested.

What is New:

• Before diagnosis, NT-proBNP increases with time and is significantly higher at 6 days from first symptoms than at 3 days suggesting different cut-offs depending on the timing of measurement.

• From diagnosis and treatment initiation, the 50% NT-proBNP drop occurs earlier in children with high NT-proBNP at diagnosis > 11,000 pg/mL and later in children with persistent fever.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

COVID-19:

Coronavirus disease 19

CRP:

C reactive protein

IV:

Intravenous

MIS-C:

Multisystem inflammatory syndrome in children

NT-proBNP:

N-terminal pro-B-type natriuretic peptide

WHO:

World Health Organization

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Acknowledgements

We acknowledge the patients and their family, as well as the teams who took part to their care.

Funding

Naïm Ouldali was funded by the ReCH-MIE Grant n°RECHMIE-22–0004 from the Ministry of Health and Prevention. The other authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Paediatric Cardiology, Univ. Lille, CHU Lille, 2 Avenue Oscar Lambret, F-59000, Lille, France

    Saïd Bichali, François Godart & Ali Houeijeh

  2. General Paediatrics, Univ. Paris, APHP CHU Robert Debré, Paris, France

    Naïm Ouldali

  3. Infectious Diseases, Univ. Montreal, CHU Sainte Justine, QC, Canada

    Naïm Ouldali

  4. ACTIV, Association Clinique Et Thérapeutique Infantile du Val-de-Marne, Créteil, France

    Naïm Ouldali

  5. UMR 1123, Univ. Paris, INSERM, ECEVE, Paris, France

    Naïm Ouldali

  6. Centre de Biologie-Pathologie, Univ. Lille, CHU Lille, F-59000, Lille, France

    Patrice Maboudou

  7. ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, Univ. Lille, CHU Lille, F-59000, Lille, France

    Stéphane Leteurtre

Authors
  1. Saïd Bichali
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Contributions

S.B. conceptualized and designed the study, coordinated data collection, carried out the initial analyses, performed interpretation of data, drafted the initial manuscript, and critically reviewed and revised the manuscript. N.O., F.G., P.M., A.H., and S.L. critically reviewed and revised the manuscript.

Corresponding author

Correspondence to Saïd Bichali.

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Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki and was validated by the local ethics committee in agreement with French regulations for such observational studies.

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Informed consent was obtained from all individual participants included in the study or their parent or legal guardian.

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The authors have no relevant financial or non-financial interests to disclose.

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Bichali, S., Ouldali, N., Godart, F. et al. NT-proBNP course during MIS-C post-COVID-19: an observational study. Eur J Pediatr 183, 1667–1674 (2024). https://doi.org/10.1007/s00431-023-05353-x

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