• Chien-Chang Lee, Xiulan Lu, Zhenghui Xiao, Meiyu Yang, and Yimin Zhu.
• *Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou †Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan ‡Department of Critical Care Medicine, Hunan Children's Hospital §Department of Pediatrics, Hunan Provincial People's Hospital, Changsha, Hunan Province, China.
• Shock. 2016 Jun 1; 45 (6): 620-5.

ObjectiveOur goal is to determine the prognostic value of serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP), leukocytosis, and hyperglycemia in patients with severe hand, foot, and mouth disease (HFMD).DesignThis is a prospective cohort study conducted from March 2011 through October 2012 at Hunan Children's Hospital.SettingHunan Children's Hospital, a large children's teaching hospital with 1,500-beds located in the Changsha region of Hunan Province in China.Patients295 children who were presented with clinical manifestation of severe HFMD, and required hospitalization.InterventionsStandard supportive treatment for HFMD as recommended by the national guidelines.MeasurementsAdmission blood samples were analyzed for NT-proBNP, leukocyte count, and serum glucose. Independent prognostic value of NT-proBNP for predicting mortality was evaluated using the Cox proportional hazard model adjusting for various covariates.Main ResultsArea under the curve of receiver operating characteristic (AUROC) analysis suggested that a serum concentration of NT-proBNP concentration more than 1,500 pg/mL is an optimal cutoff point. Twenty-four patients (8.1%) had an NT-proBNP more than 1,500 pg/mL, and a 3-day mortality of 46% (11/24). Adjusted for tachycardia, tachypnea, hypertension, hyperglycemia, leukocytosis, and conscious disturbance on presentation, elevated NT-proBNP was associated with a 22.5-fold (95% confidence interval, 3.56-142.66) increased risk of 3-day mortality. We have further improved the specificity and AUROC values by the HFMD laboratory score, which combines NT-proBNP, leukocytosis, and hyperglycemia.ConclusionsRoutine admission surveillance for NT-proBNP is useful for identifying patients with HFMD at risk for mortality. Further studies are needed to determine whether early intervention in patients with highly elevated NT-proBNP can improve outcome.

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