Pathogenic Characteristics of Severe Hand-Foot-and-Mouth Disease in Children and the Diagnostic Value of Serum NT-proBNP and hs-CRP Levels for Assessing Heart Failure in Pediatric Patients

Fan Xindan; Gao Fan

doi:10.3969/j.issn.1004-5775.2025.23.010

Abstract：Objective:To explore the pathogenetic characteristics of severe hand-foot-and-mouth disease(HFMD)in children and evaluate the diagnostic value of serum N-terminal pro-B-type natriuretic peptide(NT-proBNP)and high-sensitivity C-reactive protein(hs-CRP)levels in assessing cardiac failure in pediatric patients.Methods:Selecting 89 critically ill children with HFMD admitted to the sample hospital between November 2019 and November 2023.Pathogenetic characteristics,incidence of heart failure,and serum NT-proBNP and hs-CRP levels were collected for these patients.Results:There was statistical significance in the comparison of viral detection rates among patients across different seasons of onset,residential areas,malnutrition status,handwashing frequency,and bedsheet changing frequency(P＜0.05).Multivariate logistic regression analysis revealed that season of onset,place of residence,and frequency of bedsheet washing were significant factors associated with positive pathogen detection in severe HFMD cases(P＜0.05).Serum NT-proBNP and hs-CRP levels,left ventricular end-diastolic diameter(LVEDd),and left ventricular end-systolic diameter(LVESd)were higher in children with heart failure compared to those without heart failure,while left ventricular ejection fraction(LVEF)and left ventricular shortening fraction(LVFS)were lower in children with heart failure compared to those without heart failure(P＜0.05).Pearson correlation analysis demonstrated that serum NT-proBNP positively correlated with LVEDd and LVESd,while negatively correlated with LVEF and LVFS(r=0.419,0.538,-0.622,-0.397,P＜0.001).The hs-CRP was positively correlated with LVEDd and LVESd,and negatively correlated with LVEF and LVFS(r=0.537,0.408,-0.376,-0.625,P＜0.001).The receiver operating characteristic curves showed that the areas under the curve(AUC)for assessing pediatric heart failure using serum NT-proBNP,hs-CRP,LVEDd,LVEF,LVESd,and LVFS were 0.708,0.773,0.805,0.848,0.819,and 0.837,respectively.The AUC for combined NT-proBNP and hs-CRP assessment was 0.912.Conclusion:The primary pathogen causing severe HFMD in children is EV17.The combined use of NT-proBNP and hs-CRP enhances the assessment value for evaluating heart failure complications in pediatric patients.