# Prognostic Value of Cardiac Biomarkers in Children with Acute Bronchiolitis

## Authors

- Ufuk Utku Gullu ([ORCID](https://orcid.org/0000-0002-5561-3598)) — Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty
- Sevcan Ipek ([ORCID](https://orcid.org/0000-0002-1406-4895)) — Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty

## Article information

- **Journal:** The Ulutas Medical Journal (Ulutas Med J), ISSN 2149-388X
- **Issue:** Volume 8, Issue 3 (2022), pages 93–99
- **Article type:** Original Article
- **Published online:** 2022-09-09
- **DOI:** [10.5455/umj.20220630104800](https://doi.org/10.5455/umj.20220630104800)
- **Licence:** [CC BY-NC 4.0](https://creativecommons.org/licenses/by-nc/4.0/)
- **Article page:** https://www.ulutasmedicaljournal.com/?mno=72749
- **PDF:** https://www.ulutasmedicaljournal.com/pdf/72749.pdf

## Abstract

Introduction: Determining the severity of acute bronchiolitis in children is important for the clinical management of the disease. Therefore, we aimed to reveal their prognostic importance by examining cardiac markers in our patients with acute bronchiolitis. Materials and Methods: We conducted a single-center retrospective, observational study with children with acute bronchiolitis between 1 month and 2 years of age, between December 2020 and December 2021, who were covid-19 PCR test negative and had no covid-19 contact. We scanned demographic, clinical and laboratory parameters from medical records. Results: A total of 45 (44% female) children with acute bronchiolitis, a median (IQR) age of 5 (5) months were included in the study. There were 7 (16%) mild bronchiolitis, 23 (51%) moderate and 15 (33%) severe bronchiolitis patients. The cutoff point of Nt-proBNP to be ≥1025 ng/L to predict severe bronchiolitis with a sensitivity of 71% and a specificity of 80 % at admission in children with acute bronchiolitis. Conclusion: We think that the threshold value for Nt-proBNP in the study can be used to identify patients with severe bronchiolitis in the early period and to reduce mortality and morbidity by earlier intervention.

## Keywords

Nt-proBNP; troponin-I; bronchiolitis; respiratory; children

## How to cite

Gullu UU, Ipek S. Prognostic Value of Cardiac Biomarkers in Children with Acute Bronchiolitis. Ulutas Med J. 2022;8(3):93-99. doi:10.5455/umj.20220630104800

## References

1. Perk Y, Özdil M. Respiratory syncytial virüs infections in neonates and infants. Turk pediatri arsivi. 2018;53(2):63-70. https://doi.org/10.5152/turkpediatriars.2018.6939
2. Ferrero F, Ossorio MF, Rial MJ. The return of RSV. Pediatric pulmonology. 2021. https://doi.org/10.22541/au.163872623.38837838/v1
3. Kenmoe S, Kengne-Nde C, Ebogo-Belobo JT, Mbaga DS, Fatawou Modiyinji A, Njouom R. Systematic review and meta-analysis of the prevalence of common respiratory viruses in children < 2 years with bronchiolitis in the pre-COVID-19 pandemic era. PloS one. 2020;15(11):e0242302. https://doi.org/10.1371/journal.pone.0242302
4. Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. Global estimate of the incidence of clinical pneumonia among children under five years of age. Bulletin of the World Health Organization. 2004;82(12):895-903.
5. Üzüm Ö, Kanık A, Eliaçık K, Hortu HÖ, Demirçelik Y, Yan M, et al. Akut bronşiolitli olgularda klinik ilişkili faktörler ve tedavi yaklaşımlarının karşılaştırılması. 2020;55(4). https://doi.org/10.14744/turkpediatriars.2020.46144
6. Biggerstaff S, Markham JL, Winer JC, Richardson T, Berg KJ. Impact of High Flow Nasal Cannula on Resource Utilization in Bronchiolitis. Hospital pediatrics. 2021. https://doi.org/10.1542/hpeds.2021-005846
7. Angurana SK, Takia L, Sarkar S, Jangra I, Bora I, Ratho RK, et al. Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis: A Prospective Observational Study. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2021;25(11):1301-7. https://doi.org/10.22541/au.160451115.57099415/v1
8. Holman RC, Shay DK, Curns AT, Lingappa JR, Anderson LJ. Risk factors for bronchiolitis-associated deaths among infants in the United States. The Pediatric infectious disease journal. 2003;22(6):483-90. https://doi.org/10.1097/01.inf.0000069765.43405.3b
9. Clerico A, Aimo A, Cantinotti M. Cardiac biomarkers for outcome prediction in infant bronchiolitis: Too soon to discard troponin? Clinica chimica acta; international journal of clinical chemistry. 2021;518:170-2. https://doi.org/10.1016/j.cca.2021.04.004
10. Rodriguez-Gonzalez M, Perez-Reviriego AA, Castellano-Martinez A, Cascales-Poyatos HM. The Assessment of Myocardial Strain by Cardiac Imaging in Healthy Infants with Acute Bronchiolitis: A Systematic Review and Meta-Analysis. Diagnostics (Basel, Switzerland). 2020;10(6). https://doi.org/10.3390/diagnostics10060382
11. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118(4):1774-93. https://doi.org/10.1542/peds.2006-2223
12. Wang EE, Milner RA, Navas L, Maj H. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. The American review of respiratory disease. 1992;145(1):106-9. https://doi.org/10.1164/ajrccm/145.1.106
13. Doğan M, Köse M, Öztürk MA, Hangül M, Aslaner H. The relationship between immature platelet fraction and severity of acute bronchiolitis. The Turkish journal of pediatrics. 2021;63(6):1056-63. https://doi.org/10.24953/turkjped.2021.06.014
14. Bressan S, Balzani M, Krauss B, Pettenazzo A, Zanconato S, Baraldi E. High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: a pilot study. European journal of pediatrics. 2013;172(12):1649-56. https://doi.org/10.1007/s00431-013-2094-4
15. Kiess A, Green J, Willenberg A, Ceglarek U, Dähnert I, Jurkutat A, et al. Age-Dependent Reference Values for hs-Troponin T and NT-proBNP and Determining Factors in a Cohort of Healthy Children (The LIFE Child Study). Pediatric cardiology. 2022;43(5):1071-83. 99 77 Cardiac Biomarkers in Acute Bronchiolitis Gullu et al. https://doi.org/10.1007/s00246-022-02827-x
16. İpek S, Gungor S, Güllü UU, Dalkıran T, Mercan M, Demiray Ş, et al. Snakebites in Pediatric Patients in Kahramanmaraş: Is Pro-brain Natriuretic Peptide a Prognostic Biomarker for Snakebites? Cureus. 2022;14(1):e21570. https://doi.org/10.7759/cureus.21570
17. Fu S, Ping P, Wang F, Luo L. Synthesis, secretion, function, metabolism and application of natriuretic peptides in heart failure. Journal of biological engineering. 2018;12:2. https://doi.org/10.1186/s13036-017-0093-0
18. He Q, Wang D, Yang XP, Carretero OA, LaPointe MC. Inducible regulation of human brain natriuretic peptide promoter in transgenic mice. American journal of physiology Heart and circulatory physiology. 2001;280(1):H368-76. https://doi.org/10.1152/ajpheart.2001.280.1.h368
19. Smits AJ, Botros L, Mol MAE, Ziesemer KA, Wilkins MR, Vonk Noordegraaf A, et al. A systematic review with meta-analysis of biomarkers for detection of pulmonary arterial hypertension. ERJ open research. 2022;8(2). https://doi.org/10.1183/23120541.00009-2022
20. Rodríguez-González M, Estepa-Pedregosa L, Estalella-Mendoza A, Castellano-Martínez A, Rodríguez-Campoy P, Carlos Flores-González J. Early elevated NT-proBNP but not troponin I is associated with severe bronchiolitis in infants. Clinica chimica acta; international journal of clinical chemistry. 2021;518:173-9. https://doi.org/10.1016/j.cca.2021.03.023
21. Rodriguez-Gonzalez M, Perez-Reviriego AA, Castellano-Martinez A, Lubian-Lopez S, Benavente-Fernandez I. Left Ventricular Dysfunction and Plasmatic NT-proBNP Are Associated with Adverse Evolution in Respiratory Syncytial Virus Bronchiolitis. Diagnostics (Basel, Switzerland). 2019;9(3). https://doi.org/10.3390/diagnostics9030085
22. Rodríguez-González M, Estepa-Pedregosa L, Estalella-Mendoza A, Rodríguez-Campoy P, Romero-Castillo E, Castellano-Martínez A, et al. Routine laboratory test to assess the need of respiratory support in acute bronchiolitis. Pediatric pulmonology. 2022;57(5):1339-47. https://doi.org/10.1002/ppul.25870
23. Chaulin AM. Features of the Metabolisms of Cardiac Troponin Molecules-Part 1: The Main Stages of Metabolism, Release Stage. Current issues in molecular biology. 2022;44(3):1376-94. https://doi.org/10.3390/cimb44030092
24. Yoldaş T, Örün UA. What is the Significance of Elevated Troponin I in Children and Adolescents? A Diagnostic Approach. Pediatric cardiology. 2019;40(8):1638-44. https://doi.org/10.1007/s00246-019-02198-w
25. Dionne A, Kheir JN, Sleeper LA, Esch JJ, Breitbart RE. Value of Troponin Testing for Detection of Heart Disease in Previously Healthy Children. Journal of the American Heart Association. 2020;9(4):e012897. https://doi.org/10.1161/jaha.119.012897
26. Rodriguez-Gonzalez M, Rodriguez-Campoy P, Estalella-Mendoza A, Castellano-Martinez A, Flores-Gonzalez JC. Characterization of Cardiopulmonary Interactions and Exploring Their Prognostic Value in Acute Bronchiolitis: A Prospective Cardiopulmonary Ultrasound Study. Tomography (Ann Arbor, Mich). 2022;8(1):142-57. https://doi.org/10.3390/tomography8010012
27. Fujiogi M, Goto T, Yasunaga H, Fujishiro J, Mansbach JM, Camargo CA, Jr., et al. Trends in Bronchiolitis Hospitalizations in the United States: 2000-2016. Pediatrics. 2019;144(6). https://doi.org/10.1542/peds.2019-2614
28. De Paulis M, Oliveira DBL, Thomazelli LM, Ferraro AA, Durigon EL, Vieira SE. The importance of viral load in the severity of acute bronchiolitis in hospitalized infants. Clinics (Sao Paulo, Brazil). 2021;76:e3192. https://doi.org/10.6061/clinics/2021/e3192
29. Özgür Ö, YILDIZDAŞ D, HOROZ ÖÖ, EKİNCİ F, MISIRLIOĞLU MJCMJ. Solunum sinsityal virüsü ile ilişkili bronşiyolite bağlı solunum sıkıntısı gelişen trakeostomili bir çocuk olguda Heliox tedavisi kullanımı.45(3):1257-60.
30. Kepreotes E, Whitehead B, Attia J, Oldmeadow C, Collison A, Searles A, et al. High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial. Lancet (London, England). 2017;389(10072):930-9. https://doi.org/10.1016/s0140-6736(17)30061-2
31. Eşki A, Öztürk GK, Turan C, Özgül S, Gülen F, Demir E. High-flow nasal cannula oxygen in children with bronchiolitis: A randomized controlled trial. Pediatric pulmonology. 2022;57(6):1527-34. https://doi.org/10.1002/ppul.25893
32. Franklin D, Babl FE, Schlapbach LJ, Oakley E, Craig S, Neutze J, et al. A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. The New England journal of medicine. 2018;378(12):1121-31. https://doi.org/10.1056/nejmoa1714855
33. Aslan Y, Koca L, Mutlu M, Tekelioglu Y, Erduran E. Apopitotic effects of dopamine and dobutamine on neutrophils of premature neonates. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2011;24(9):1155-8. https://doi.org/10.3109/14767058.2010.545914
34. Mahoney L, Shah G, Crook D, Rojas-Anaya H, Rabe H. A Literature Review of the Pharmacokinetics and Pharmacodynamics of Dobutamine in Neonates. Pediatric cardiology. 2016;37(1):14-23. https://doi.org/10.1007/s00246-015-1263-9
35. Sebina I, Phipps S. The Contribution of Neutrophils to the Pathogenesis of RSV Bronchiolitis. Viruses. 2020;12(8). https://doi.org/10.3390/v12080808
