N-terminal Pro-Brain Natriuretic Peptide (NT proBNP) as a Predictive Indicator of Initial Intravenous Immunoglobulin Treatment Failure in Children With Kawasaki Disease: A Retrospective Study

Abstract

Intravenous immunoglobulin (IVIG) administered in the acute stage of Kawasaki disease (KD) is the standard therapy. Few reports describe nonresponders to initial treatment with IVIG in KD, which remains the most consistent risk factor for coronary artery lesions (CALs). This study aimed to investigate whether the serum level of N-terminal pro-brain natriuretic peptide (NT-proBNP) can be a predictive indicator for identifying patients with KD at higher risk of IVIG treatment failure. In this study, 135 patients with a diagnosis of KD admitted for IVIG treatment were retrospectively enrolled for analysis. Of these 135 patients, 22 were nonresponders who received additional rescue therapy because they had an elevated body temperature 36 h after completion of initial IVIG treatment. The NT-proBNP concentration was significantly higher in the nonresponder group (2,465.36 ± 3,293.24 pg/mL) than in the responder group (942.38 ± 1,293.48 pg/mL) (p < 0.05). The optimal sensitivity and specificity cutoff point for predicted nonresponders was 1,093.00 pg/mL or higher. The sensitivity and specificity for prediction of IVIG response were respectively 70.0 and 76.5 %. The findings show that NT-proBNP is a helpful marker in determining patients at risk for not responding to initial IVIG treatment. The authors suggest that patients with an NT-proBNP level of 1,093.00 pg/dL or higher are likely to fail initial IVIG and may require further rescue therapy.

Risk of coronary artery lesions in young infants with Kawasaki disease: need for a new diagnostic method

“…NT‐proBNP had a high diagnostic value for identifying KD in patients with protracted undifferentiated febrile illness . Moreover, elevated NT‐proBNP could be a predictive factor for CAL and IVIg resistance in KD . In our study, the serum NT‐proBNP level in young infant KD patients was significantly higher than that in patients with other febrile illnesses, but was not a suitable predictive factor for CAL (3760 ± 2678 pg/mL of KD with CAL vs .…”

N-terminal pro-brain natriuretic peptide in acute Kawasaki disease correlates with coronary artery involvement

“…Several series report the use of N-terminal pro-brain natriuretic peptide for diagnosis [15][16][17][18][19] and prognosis of Kawasaki disease, including the presence of coronary dilatation 20,21 and resistance to intravenous immunoglobulin. [22][23][24] Despite the growing interest in natriuretic peptides with respect to Kawasaki disease, very few publications have utilised age-related values 25 or age-adjusted Z-values 15 of N-terminal pro-brain natriuretic peptide. In this study, we have set out to investigate the hypothesis that suggests that elevated age-adjusted N-terminal pro-brain natriuretic peptide serum levels at the onset of Kawasaki disease correlate with coronary artery dilatation.…”

A Comprehensive Assessment of the Value of Laboratory Indices in Diagnosing Kawasaki Disease

“…Although the sensitivity was not high, the specificity was extremely high; therefore, it is believed that adoption of additional rescue therapy for these patients is an effective means by which to shorten the course of the disease and reduce the incidence of 1948 YE ET AL coronary artery lesions. Other researchers have obtained similar results (22,23), but those studies involved only small study samples. The study by Iwashima and Ishikawa (24) involved only 91 KD patients, including 14 who failed to respond to the initial IVIG infusion.…”