Urinary NT-proBNP as a noninvasive biomarker for pediatric septic shock: a comparative study with serum levels
- 1Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java Indonesia
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.
Methods: 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.
Results: 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).
Conclusions: 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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12887-026-07371-8.
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BibTeX
@article{fauzi2026urinary,
title = {{Urinary NT-proBNP as a noninvasive biomarker for pediatric septic shock: a comparative study with serum levels}},
author = {Fauzi and Faisal and Rahmat Budi Kuswiyanto and Rini Rossanti and Dzulfikar Djalil Lukmanul Hakim and Sri Endah Rahayuningsih},
journal = {BMC Pediatrics},
year = {2026},
month = jul,
doi = {10.1186/s12887-026-07371-8},
url = {https://doi.org/10.1186/s12887-026-07371-8},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Urinary NT-proBNP as a noninvasive biomarker for pediatric septic shock: a comparative study with serum levels
AU - Fauzi
AU - Faisal
AU - Rahmat Budi Kuswiyanto
AU - Rini Rossanti
AU - Dzulfikar Djalil Lukmanul Hakim
AU - Sri Endah Rahayuningsih
PY - 2026
DA - 2026/07/29
JO - BMC Pediatrics
DO - 10.1186/s12887-026-07371-8
UR - https://doi.org/10.1186/s12887-026-07371-8
AB - 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. Methods: 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. Results: 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). Conclusions: 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12887-026-07371-8.
SN - 1471-2431
ER -