A comparative study of IL‐6, CRP and NT‐proBNP levels in post‐COVID multisystem inflammatory syndrome in children (MISC) and Kawasaki disease patients

Abstract

Background Post‐COVID multisystem hyperinflammatory syndrome in children (MISC) has clinical and laboratory similarities with Kawasaki disease (KD). Inflammatory markers like C‐reactive protein (CRP), interleukin 6 (IL6) as well as N‐terminal probrain natriuretic peptide (NT‐proBNP) are elevated in both. This study attempts a comparative analysis of the 3 markers in an attempt at early differentiation for planning appropriate management. Methodology This analytical study conducted at the Institute of Child Health, Kolkata, India compared the levels of the above 3 markers at admission between 72 patients with KD, 30% of whom had coronary artery lesions (CALs) collected over a period of 18 months (Jan 2017‐June 2018), with 71 MISC patients over a period of 6 months (July 2020‐December 2020). The non‐parametric Mann‐Whitney U test was used to test for similarity in distributions of the samples of CRP, NT‐proBNP and IL6 in KD and MISC patients using correction factor for similar ranks. The 3 parameters were compared using receiver operating characteristic (ROC) curve analysis. Results Mean IL6 value in KD was 83.22 pg/mL and in MISC 199.91 pg/mL, which was not found to be statistically significant ( P = .322 > .05).However mean NT‐proBNP (914.91 pg/mL) with CRP level (96.32 mg/L) in KD was significantly lower ( P < .05 for both cases) than that in MISC (9141.16 pg/mL and 145.66 mg/L respectively). ROC analysis showed NT‐proBNP has the best sensitivity and specificity in predicting MISC. Conclusion NT‐proBNP and CRP are significantly higher among MISC patients; ROC analysis shows levels >935.7 pg/mL and >99.55 mg/L respectively might act as a guide to differentiate between them.

Long-term cardiovascular outcomes in COVID-19 survivors among non-vaccinated population: A retrospective cohort study from the TriNetX US collaborative networks

“… 21 , 22 Furthermore, SARS-CoV-2 infection can trigger a cytokine storm; many pro-inflammatory cytokines and chemokines, such as TNF-α, IL-1β, and IL-6, are overproduced, damaging various organs, including those in the cardiovascular system. 23 , 24 Additionally, cardiovascular risk factors, such as hypertension and diabetes, have been reported to be significant in COVID-19 patients and the mortality rate in former studies. 25 , 26 , 27 COVID-19 itself can also induce cardiovascular complications.…”

Cardiac dysfunction in Multisystem Inflammatory Syndrome in Children: An Italian single-center study

“…It is known that NTproBNP is associated with myocardial damage, stress, and fibrosis, and high NTproBNP levels constitute an independent diagnostic criterion for heart failure. However, it is also known that inflammation appears to be associated with natriuretic peptide release [30,31]. Increasing NTproBNP in MIS-C without severe cardiac involvement may be related to the significant inflammatory state.…”

Advanced Echocardiographic Analysis in Medium-Term Follow-Up of Children with Previous Multisystem Inflammatory Syndrome

“…Although, in most cases, cardiac dysfunction seems the result of the hyperinflammatory state and the cytokine storm that cause myocardial stunning and perivascular edema, rather than a direct myocyte injury or an immune-mediated viral trigger. The hypothesis is supported by the disproportion between myocardial damage and the relatively low increase in troponin serum level, while there is a direct correlation between the severity of heart involvement and NTproBNP and inflammatory markers [ 10 , 39 ]. Trisha P. et al showed a significant difference in time to recovery of LVEF comparing classic myocarditis and myocarditis linked to MIS-C (70% vs. 93%) and a significant difference in the needed heart failure medications at three months post-discharge (only 2.2% in MIS-C vs. 45% in classic myocarditis).…”