Paediatrica Indonesiana, Vol. 66, No. 3, May 2026
Factors influencing NT-proBNP levels in pediatric patients with thalassemia major
Azizah Chairiani, Department of Pediatric, Faculty of Medicine, Sebelas Maret University, Surakarta
Muhammad Riza, Pediatrician, Department of Pediatric, Faculty of Medicine, Sebelas Maret University, Surakarta
Bagus Artiko Pediatrician, Department of Pediatric, Faculty of Medicine, Sebelas Maret University, Surakarta
Abstract
Background Children with β-thalassemia major are at risk of early cardiac dysfunction due to chronic anemia and transfusion-related iron overload. The NT-proBNP is a widely used biomarker for cardiac stress, yet its clinical correlates in pediatric thalassemia remain insufficiently defined.
Objective To evaluate the relationship between NT-proBNP levels and clinical variables, including hemoglobin, ferritin, transfusion parameters, and nutritional status, in children with β-thalassemia major receiving routine transfusions.
Methods A cross-sectional study was conducted on 68 pediatric patients at Dr. Moewardi General Hospital, Surakarta. The NTproBNP, hemoglobin, ferritin, transfusion volume (mL/kg body weight) based on the most recent transfusion episode, anthropometric, and chelation data were collected. Correlation tests, multivariate bootstrapped linear regression, and logistic regression were used to identify clinical predictors of elevated NT-proBNP (≥125 pg/mL).
Results Median NT-proBNP was 161.5 pg/mL, with 63.2% of participants exceeding the 125 pg/mL threshold. NT-proBNP showed a significant negative correlation with hemoglobin (ρ=-0.298; P=0.014) and a significant positive correlation with transfusion volume per kilogram (ρ=0.412; P<0.001). Ferritin, duration of transfusion, nutritional status, age, sex, and chelation dose were not significantly associated with NT-proBNP levels. In multivariate analysis, transfusion volume remained a significant positive predictor of higher NT-proBNP (B=9.33; P=0.033), whereas hemoglobin showed a non-significant negative trend (B=–23.52; P=0.093).
Conclusion NT-proBNP elevation in pediatric β-thalassemia major is significantly associated with hemoglobin level and transfusion volume rather than iron overload indicators. NT-proBNP may serve as an early marker of cardiac strain, but imaging remains needed to distinguish from subclinical cardiomyopathy.
[Paediatr Indones. 2026;66:233-40; DOI: https://doi.org/10.14238/ pi66.3.2026.233-40 ].
Keywords: β-thalassemia major; NT-proBNP; transfusion volume; anemia; iron overload; cardiac stress biomarker
Corresponding author: Azizah Chairiani. Faculty of Medicine, Universitas Sebelas Maret, Building G Floor 2, Jalan IR Sutami 36A, Kentingan, Jebres, Surakarta 57126, Central Java, Indonesia. Fax: +62 271 637400. Email: chaiririani@gmail.com.