Brain natriuretic peptide as an early predictor of toxic myocarditis after burn injury: A prospective observational study

Background & objective: Thermal injury is a serious medical condition that could be associated with toxic myocarditis (TM). Cardiac troponins are the biomarkers of choice for the detection of cardiac injury; however, a negative troponin does not exclude the diagnosis of myocarditis. Brain natriuretic peptide (BNP) could be valuable in such cases and its role in burn injuries remains unexplored. We conducted this study to evaluate the use of the plasma concentration of BNP as an early predictor of postburn TM. Methodology: Forty adult patients were included in this prospective observational study with total burn surface area (TSBA) ≥ 20% up to ≤ 50% with 2nd degree burn or more. The primary outcome was the sensitivity and specificity of the BNP plasma level as an early predictor of the incidence of TM while the secondary outcomes were ICU stay, and total hospital stay. Results: 16 out of 40 patients developed TM by symptoms and echo findings (Group TM) and 24 patients didn’t (Group NTM). BNP was significantly elevated in Group TM than Group NTM on day 1, 4 and 7 (P< 0.0001) and it was significantly higher than troponin I on day 1 (95%CI = 0.888 to 1.000 for BNP vs 0.538 to 0. 837 for troponin). Sepsis, ICU and hospital stay were not significantly different between both groups (P = 0.134, 0.1136, 0. 1176 for each respectively). Conclusion: BNP can serve as an early predictor of toxic myocarditis in patients with severe burn injuries. Abbreviations: ANP: Atrial natriuretic peptide, BNP: Brain natriuretic peptide, cTnI: cardiac Troponin I, EMB: endomyocardial biopsy, TM: toxic myocarditis, TSBA: total burn surface area, Keywords: Brain Natriuretic Peptide; Burn; Toxic Myocarditis; Troponin Citation: Abd Elaziz ITM, Nasr NS, Farag HM, Elbeialy MAK, Salem LE, Salem M. Brain natriuretic peptide as an early predictor of toxic myocarditis after burn injury: A prospective observational study. Anaesth. pain intensive care 2025;29(3):458-466. DOI: 10.35975/apic.v29i3.2757 Received: May 09, 2024; Revised: October 26, 2024; Accepted: January 01, 2025