Background Severe enterovirus 71 (EV71) infection in children can result in high morbidity and mortality. The purpose of this study was to use biomarkers for detection of EV71 infection with cardiac involvement.
Methods A total of 53 children, aged 2.5 ± 1.7 years, were studied. Patients were divided into three groups. Group I comprised 30 normal control patients. Group II included 20 patients with EV71-stage 2 infection, and group III included 3 patients with EV71-stage 3 infection. The demographic data, laboratory results and plasma BNP levels were statistically analysed.
Results All group II patients recovered completely without neurological sequelae. Two patients in group III were rescued by ECMO and successfully weaned off and survived without cardiac complications. The group III patients had higher plasma troponin-I, creatine kinase-MB fraction, B-type natriuretic peptide (BNP) level and BNP z-score than those of other groups. The median BNP values were < 5, 9.5 and 238 pg/mL, and median of BNP z-scores were -2.02, -0.22, and 6.11 in the three groups, respectively. Using a BNP cut-off value of 100 to identify cases with concomitant severe EV71 infection and acute heart failure, the sensitivity and specificity were 100% and 100%, respectively. The group III patients had higher urine catecholamine levels than those of group II (p < 0.01).
Conclusions Children with severe EV71 infection have varying degrees of myocardial stress that would be caused by hypercatecholaminemia. Plasma BNP is a sensitive and reliable cardiac biomarker for detection of cardiac involvement in children with severe EV71 infection.
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