American Journal of Epidemiology and Infectious Disease
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American Journal of Epidemiology and Infectious Disease. 2016, 4(6), 105-109
DOI: 10.12691/ajeid-4-6-1
Open AccessArticle

BNP as Predictor of Pediatric Severe Sepsis Fluid Responsiveness in Limited Resource Setting Country

Nanan Sekarwana1, Heda Melinda Nataprawira1, , Nur Melani Sari1, Dadang Hudaya Somasetia1 and Rahmat Budi Kuswiyanto1

1Department of Child Health, Dr. Hasan Sadikin General Hospital-Universitas Padjadjaran, Bandung, Indonesia

Pub. Date: December 30, 2016

Cite this paper:
Nanan Sekarwana, Heda Melinda Nataprawira, Nur Melani Sari, Dadang Hudaya Somasetia and Rahmat Budi Kuswiyanto. BNP as Predictor of Pediatric Severe Sepsis Fluid Responsiveness in Limited Resource Setting Country. American Journal of Epidemiology and Infectious Disease. 2016; 4(6):105-109. doi: 10.12691/ajeid-4-6-1

Abstract

Fluid responsiveness is an important aspect in severe sepsis management, assessed by static and dynamic parameter tools. Unfortunately, they are not widely used in limited resource setting. Brain natriuretic peptide is cardiac hormone correlated with CVP measurement as one of the static parameter, but its associations with dynamic parameter has not studied yet. Objective: To investigate whether BNP might predict fluid responsiveness based on clinical and inferior vena cava index criteria. Study Design: A cross sectional study was conducted on 59 severe sepsis subjects aged 1–14 years who met the inclusion criteria enrolled through consecutive sampling during October 2013 to March 2014. Patients were given fluid resuscitation based on 2012 Surviving Sepsis Campaign. BNP measurements were performed at 0 and 1 hour after fluid resuscitation. Responder and non-responder groups were classified based on clinical and IVC index criteria. Ultrasound using M Mode was performed to calculate IVC index. Unpaired t test and receiver operating characteristic curves were generated for BNP to predict fluid responsiveness. Results: Baseline characteristics between responder and non-responder groups were almost similar. Initial BNP between groups using both criteria were not significantly different (p>0.05). The area under curve of BNP0 was 0.04. The best cut off values of log BNP to predict fluid responsiveness was 1.9pg/mL. BNP ≤1.9 pg/mL has a sensitivity, specificity, negative predictive value and positive predictive value of each were 50%, 50%, 50%, 50%, respectively. Conclusion: BNP cannot reflect and accurately predict fluid responsiveness due to multifactorial factors of raising BNP and mostly subject were spontaneous breathing which more difficult to predict.

Keywords:
BNP severe sepsis fluid responsiveness

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