{
  "abstract": "Background: The 2024 Phoenix Sepsis Score (PSS) may not fully capture subclinical cardiovascular stress in pediatric sepsis. N-terminal pro–B-type natriuretic peptide (NT-proBNP), released under haemodynamic strain, is measurable in urine and serum and has been associated with cardiovascular dysfunction. This study aimed to compare urinary and serum NT-proBNP levels in pediatric sepsis and septic shock, evaluate their ability to differentiate these conditions, and examine their correlations with PSS.\n\nMethods: Participants aged 1 month–18 years with sepsis or septic shock according to PSS were included in this prospective cross-sectional analytical study at a tertiary hospital in Bandung, Indonesia. Urinary and serum NT-proBNP concentrations were measured within 48 h of diagnosis. Patients with preexisting heart, kidney, or urological problems were excluded. Main analyses included Mann-Whitney U, ROC curves, and Spearman correlations. To evaluate statistical stability, 1,000 bias-corrected and accelerated (BCa) bootstrap iterations, fragility index (FI) analysis, and time-adjusted sensitivity analyses were added.\n\nResults: Final analyses comprised 52 children (26 sepsis, 26 septic shock). Median urinary NT-proBNP levels were higher in septic shock than in sepsis (8,065 vs. 210 pg/mL; p = 0.003), as were serum NT-proBNP levels (1,655 vs. 200 pg/mL; p = 0.005). Urinary NT-proBNP had an AUC of 0.743 (95% BCa CI 0.584–0.867) for septic shock (cut-off > 9,550 pg/mL, specificity 100%, sensitivity 42.3%, FI = 4), whereas serum NT-proBNP showed an AUC of 0.726 (95% BCa CI 0.573–0.852; cut-off > 1,640 pg/mL, specificity 92.3%, sensitivity 50.0%, FI = 3). Sensitivity analyses confirmed performance stability when restricting collection to ≤ 6 h. Urinary NT-proBNP correlated weakly with PSS (r = 0.261; p = 0.031), while serum NT-proBNP did not (r = 0.221; p = 0.058).\n\nConclusions: Urinary NT-proBNP demonstrated moderate discriminatory ability and high specificity for pediatric septic shock, comparable to serum NT-proBNP, although its correlation with PSS was modest. It may have potential value as an adjunctive rule-in biomarker for cardiovascular stress in pediatric sepsis, but not as a screening tool or replacement for clinical assessment. Further studies are needed to determine its broader clinical utility in pediatric sepsis.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12887-026-07371-8.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java Indonesia"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Fauzi"
    },
    {
      "affs": [
        0
      ],
      "name": "Faisal"
    },
    {
      "affs": [
        0
      ],
      "name": "Rahmat Budi Kuswiyanto"
    },
    {
      "affs": [
        0
      ],
      "name": "Rini Rossanti"
    },
    {
      "affs": [
        0
      ],
      "name": "Dzulfikar Djalil Lukmanul Hakim"
    },
    {
      "affs": [
        0
      ],
      "name": "Sri Endah Rahayuningsih"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/55gf2h3tjkmrr.bib",
  "cited_by": 0,
  "doi": "10.1186/s12887-026-07371-8",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13712029/",
  "id": "55gf2h3tjkmrr",
  "issns": [
    "1471-2431"
  ],
  "landing_url": "https://doi.org/10.1186/s12887-026-07371-8",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2713|Sepsis Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7171653187",
  "pdf_url": null,
  "pmcid": "PMC13712029",
  "pmid": "42934600",
  "published": "2026-07-29",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/55gf2h3tjkmrr.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T12:22:42Z",
      "native_id": "PMC13712029",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12887-026-07371-8"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Sepsis Diagnosis and Treatment",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Urinary NT-proBNP as a noninvasive biomarker for pediatric septic shock: a comparative study with serum levels",
  "title_text": "Urinary NT-proBNP as a noninvasive biomarker for pediatric septic shock: a comparative study with serum levels",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:22:42Z",
  "url": "https://research.draconitic.com/paper/55gf2h3tjkmrr",
  "venue": "BMC Pediatrics",
  "versions": []
}