Blood N-terminal pro-brain natriuretic peptide and interleukin-17 for distinguishing incomplete Kawasaki disease from infectious diseases

Wu, Lawrence Shih Hsin; Chen, Yuanling; Zhong, Shiling; Li, Yunyan; Dai, Xiahua; Di, Yazhen

doi:10.1007/s13312-015-0659-1

Cited by 10 publications

(3 citation statements)

References 12 publications

(11 reference statements)

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“…Th17 cytokine (IL-17) has also been found to be elevated in the acute phase of KD. Wu et al 57 evaluated the diagnostic utility of NT-proBNP (N-terminal pro-brain natriuretic peptide) and IL-17 to differentiate incomplete KD from other febrile infectious illnesses of childhood and found that when the cut-offs for IL-17 and NT-proBNP were set at 11.55 pg/mL and 225.5 pg/dL, respectively, the sensitivity and specificity of differentiating incomplete KD from infectious illnesses reached as high as 86.5% and 94.8%, respectively. NT-pro-BNP estimation (a marker of myocardial damage) has recently been evaluated for inclusion in the diagnostic criteria of KD.…”

Section: Biomarkers In Kdmentioning

confidence: 99%

Diagnosis of Kawasaki disease

2017

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Kawasaki disease (KD) is a medium vessel vasculitis with predilection for coronary arteries. Due to lack of a reliable confirmatory laboratory test, the diagnosis of KD is based on a constellation of clinical findings that appear in a typical temporal sequence. These diagnostic criteria have been modified from time to time and the most recent guidelines have been proposed by the American Heart Association (AHA) in 2017. However, several children may have incomplete or atypical forms of KD and the diagnosis can often be difficult, especially in infants and young children. In this review, we have detailed the steps involved in arriving at a diagnosis of KD and also highlight the important role of echocardiography in diagnosis and management of children with KD.

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Section: Biomarkers In Kdmentioning

confidence: 99%

Diagnosis of Kawasaki disease

2017

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“…[20]BNP is a peptide synthesized and secreted by myocardial cells after myocardial stimulation,such as pressure load,ischemia,and in ammatory stimulation.It can be used as one of the important markers to re ect myocardial injury.It is recommended as a predictor of incomplete KD and coronary artery damage,and indirectly re ects the in ammatory response of KD. [21,22]In this study, we found that the BNP level in the acute phase of the liver injury group (556 pg/ml)was signi cantly higher than that of the control group(441 pg/ml),suggesting that the liver injury group might have a stronger in ammatory response in the acute phase of the disease.…”

Section: Discussionmentioning

confidence: 54%

Factors associated with liver injury after intravenous gamma globulin treatment in children with Kawasaki disease

Ren

et al. 2022

Preprint

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Background: The etiology of liver injury in children with Kawasaki disease(KD) is not yet clear.It is common for children who are responded to intravenous gamma globulin (IVIG) therapy to develop liver injury after IVIG treatment. This research is to explore related factors of liver injury after IVIG treatment in children with KD who responded retrospectively to IVIG.Methods: A total of 806 children with KD were included in this analysis. The clinical characteristics, laboratory findings, and drug use before IVIG were collected. Difference analysis, ROC curve analysis and logistic regression analysis were performed to obtain possible risk factors for liver injury after IVIG treatment.Results: Among the clinical symptoms of the two groups of children, children with lymphadenopathy had a lower risk of developing liver injury after IVIG treatment(p=0.040),while there were no significant differences in other symptoms. Among laboratory indicators, the liver injury group had higher levels of platelet(PLT),eosinophil(EO) and brain natriuretic peptide(BNP) levels and lower hemoglobin(HB),erythrocyte sedimentation rate(ESR) and prothrombin time(PT) levels before IVIG treatment (p<0.05).There were no significant difference in c-reactive protein(CRP) and Procalcitonin(PCT)(p>0.05).The use of antibiotics, dipyridamole and aspirin doses between two groups had statistically significant differences(p>0.05).Further ROC curve analysis of aspirin dose found the optimal cut-off point of aspirin was 34.7 mg/(k*d)(the 95% CI: 0.504-0.601,p=0.026).The logistic regression analysis showed high-dose aspirin (≥34.7mg/(kg*d))was a risk factor for liver damage after IVIG treatment in KD children. Further multivariate regression analysis prompted that the use of antibiotics and higher doses of aspirin(≥34.7mg/(kg*d))in the acute phase were independent risk factors for liver injury after IVIG treatment in children with KD(Antibiotic use: OR=2.195,95%CI:1.206-3.994,p=0.01;Aspirin use: OR=1.526,95%CI:1.083-2.151,p=0.016).Conclusions: For KD children with normal liver function in the acute phase, the younger the age of KD onset, the smaller the weight, the absence of lymphadenopathy, and more elevated PLT,EO, BNP, reduced HB,ESR and PT in acute stage, the more likely to develop liver injury after treatment. There was no significant correlation between the degree of systemic inflammation(levels of CRP and PCT)in the acute phase and liver damage after IVIG treatment. The use of antibiotics and high-dose aspirin in the acute phase may be the risk factors for liver function damage after IVIG treatment in KD children.

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“…NT-proBNP and interleukin 17 (IL-17) have been found elevated in the acute phase of KD, but none of them has been validated for clinical practice. 8,17 There are various initial gastrointestinal symptoms which may confuse the clinical pictures of KD and delay diagnosis especially in patients with incomplete form of disease. Ohnishi et al reported a 4-year-old boy with KD presenting as sigmoid colitis and Rosencrantz et al reported a 2.5-year-old boy with KD presenting as sclerosing cholangitis.…”

Section: Discussionmentioning

confidence: 99%

<p>Unusual Presentation Of Kawasaki Disease With Gastrointestinal And Renal Manifestations</p>

Lazea¹,

Man

Sur³

et al. 2019

TCRM

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Diagnosis of Kawasaki disease (KD) is based on well-established clinical criteria. In incomplete or atypical KD, the diagnosis is challenging, because of the paucity of clinical signs or because of the presence of clinical manifestations that generally are not seen in KD. We describe the case of a 3-year-old female patient with persistent high fever, vomiting, watery diarrhea, metabolic acidosis and severe hypopotassemia. On the fourth day of fever, bilateral conjunctivitis, mucous and extremity changes were registered. Urine changes as glycosuria and proteinuria were also noticed. Echocardiography revealed ectasia of the left anterior descending coronary artery, and diagnosis of KD was established. The treatment consisted of intravenous immunoglobulin (IVIG) and oral aspirin. Recurrence of disease was recorded on the 23rd day of the disease, with favorable evolution after the second dose of IVIG was infused.

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Blood N-terminal pro-brain natriuretic peptide and interleukin-17 for distinguishing incomplete Kawasaki disease from infectious diseases

Cited by 10 publications

References 12 publications

Diagnosis of Kawasaki disease

Diagnosis of Kawasaki disease

Factors associated with liver injury after intravenous gamma globulin treatment in children with Kawasaki disease

<p>Unusual Presentation Of Kawasaki Disease With Gastrointestinal And Renal Manifestations</p>

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