Biomarkers in Pediatric ARDS: Future Directions

Orwoll, Benjamin E.; Sapru, Anil

Though the vast majority of biomarker data available in pediatrics fall into one of the above categories, several known markers do not fit easily into any of them. B-type (formerly known as brain-type) natriuretic peptide (BNP or pro-BNP) is a protein that has been commonly used to assess fluid status and cardiac strain in congestive heart failure and pulmonary hypertension, among others. Studies in adults have found that BNP can help discriminate ARDS from cardiogenic pulmonary edema, and higher BNP levels are associated with mortality (161) (162) (163) . Similarly, in a cohort of children with ALI, elevated BNP levels early in the disease course were associated with worse oxygenation, fewer VFDs, increased need for inotropes, and were significantly elevated among non-survivors (52) . These findings suggest BNP as a possible marker of the altered cardiopulmonary interactions that can occur in the setting of ALI in children.