Development of a Nomogram for Moderate-to-Severe Bronchopulmonary Dysplasia or Death: Role of N-Terminal Pro-brain Natriuretic Peptide as a Biomarker

Abstract

Objectives: This study aimed to explore the clinical value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting moderate-to-severe bronchopulmonary dysplasia (BPD)/death, and to establish an effective clinical predictive nomogram.Methods: We retrospectively analyzed very low birth weight infants (VLBWs) with gestational age ≤ 32 weeks. The NT-proBNP values were determined on the 1st, 3rd, 7th, 14th, 21st, and 28th days after birth. The correlation between NT-proBNP level and moderate-to-severe BPD/death was evaluated. Receiver operating characteristic (ROC) curve analysis was used to evaluate the prediction ability. Then, we used multivariable logistic regression to build the prediction model and nomogram, and calibration of the model was assessed by calibration curve.Results: In total, 556 VLBWs were involved, among whom 229 developed BPD (mild: n = 109; moderate: n = 68; severe: n = 52) and 18 died. The NT-proBNP level in the moderate-to-severe BPD/death group was significantly higher than that in the no-to-mild BPD group from the 3rd to 28th day (P < 0.001). When the natural logarithm of the serum NT-ProBNP level increased by 1 unit at day 7 (±2 days) of life, the risk of moderate and severe BPD/death was the highest (OR = 3.753; 95% CI: 2.984~4.720), and ROC analysis identified an optimal cutoff point of 3360 ng/L (sensitivity: 80.0%; specificity: 86.2%; AUC: 0.861). After adjusting for confounding factors, the level of NT-proBNP at day 7 (±2 days) of life still had important predictive value for the development of moderate-to-severe BPD/death, significantly improving the predictive ability of the model.Conclusion: The level of NT-proBNP at day 7 (±2 days) of life can be used as an early promising biomarker for VLBWs to develop moderate-to-severe BPD/death. We constructed an early predictive nomogram to help clinicians identify high-risk populations.

Urinary biomarkers for the early prediction of bronchopulmonary dysplasia in preterm infants: A pilot study

“…Our prospective study demonstrated that the urine NT-proBNP concentrations were significantly elevated from DOL 7 to 28 in preterm infants who, many weeks later, developed BPD (P < 0.05). This result linked circulatory stress to BPD in the first 4 weeks of life for preterm infants and were consistent with serum NT-proBNP level trends reported by Song et al (33). We also found that urine NT-proBNP levels from DOL 7 to 28 positively correlated with mechanical ventilation duration and oxygen exposure time.…”

“…Prenatal exposure to oxidative stress, postnatal hyperoxia, and prolonged mechanical ventilation may increase pulmonary vascularization damage by modulating vascular tone ( 34 ). Elevated serum NT-proBNP levels may be related to raised pulmonary vascular pressure and diastolic dysfunction ( 33 , 35 ). Our study discovered a persistently positive correlation between an oxidative stress-related biomarker (i.e., 8-OHdG) and NT-proBNP levels in urine from DOL 7 to 28 (r: 0.655–0.789, P < 0.001).…”

Correlation between urinary and serum NT‐proBNP in acute bronchiolitis: A pilot study

“…The dynamics and values of NT‐proBNP levels are similar in premature infants compared with healthy term infants, reaching stable plateau values after the first month of life 30,31 . The pCA and prematurity related comorbidities (BPD and hs‐PDA) seem to affect NT‐proBNP concentrations more than the GA, but their influence is rarely present after a pCA of >36 weeks 28–32 . Therefore, our small sample size including infants with a median pCA of 46 +1 weeks, 4 premature infants all with pCA >36 weeks, and only 1 patient with BPD could explain our unexpected results.…”

“…The plasmatic concentration of NT-proBNP in infants is clearly influenced by the chronological age, prematurity, and its related complications (BPD, hs-PDA, …). 17,[28][29][30][31][32] As all these variables are wellknown risk factors for worse outcomes in acute bronchiolitis, their influence on NT-proBNP concentrations should be considered before stablishing the use of this biomarker in this setting. In our exploratory analysis the urinary NT-proBNP levels resulted not associated with any of these parameters.…”

Lung Ultrasound Score has Better Diagnostic Ability Than NT-PROBNP to Predict Moderate–Severe Bronchopulmonary Dysplasia

“…Different multicentre studies have demonstrated that the LUS score is also a good predictor of msBPD in children born before 32 weeks after the rst 3-7 DOLs [17,18,31]. In addition, NT-proBNP is related to msBPD prediction in the rst DOLs[8, 29,32], even after adjusting for haemodynamically signi cant PDA [7,8], and it remains related to pulmonary hypertension in preterm infants with BPD [33,34].…”