Pro-brain natriuretic peptide (ProBNP) levels in North Indian children with Kawasaki disease

Abstract

The diagnosis of Kawasaki disease (KD), a common pediatric vasculitis, is based solely on clinical criteria. There is a need for a robust laboratory marker that can help differentiate KD from other acute, febrile, childhood illnesses and also to predict cardiac involvement. We conducted a cross-sectional study of 25 consecutive patients admitted with diagnosis of KD from January 2013 to April 2014 and compared them with age- and sex-matched febrile controls. We studied the serum pro-brain natriuretic peptide (ProBNP) [ProBNP and N-terminal pro-B-type natriuretic peptide (NT-ProBNP) levels], a marker of myocardial dysfunction, in children with KD in acute and convalescent phases of disease. These levels were also estimated in febrile controls for comparison. The ProBNP (ProBNP and NT-ProBNP) levels were much higher in the acute phase of the KD patients compared to levels in the convalescent phase of KD (p = 0.000014). Similarly, the levels in the acute phase were higher when compared to the age- and sex-matched febrile controls (p = 0.000126). The receiver operating curve (ROC) analysis for the ProBNP levels in the acute phase of KD yielded an area under the curve of 0.954 ± 0.034 (p < 0.000, 95 % CI 0.886-1.0). Based on ROC analysis, a cutoff of 1025 pg/mL for ProBNP levels in the acute phase of KD had 88 % sensitivity and 96 % specificity for the diagnosis of KD. A lower cut-off of 514 pg/mL yielded a 100 % sensitivity and 80 % specificity for the diagnosis of KD. The ProBNP levels were higher in those with coronary artery abnormalities (CAA) compared to those without CAA in both acute (p = 0.013) and convalescent (p = 0.045) phases. ProBNP levels may be used as a surrogate marker for the differentiation of KD from other febrile, infectious illnesses and may also predict the involvement of coronary arteries.

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 .…”

“…Because the serum NT‐proBNP level in patients with KD might change over time in the acute phase, the timing of evaluation could affect the results. In our study, evaluation of serum NT‐proBNP levels was performed 17.5 ± 20.6 h (range: 1–96 h) after the onset of fever, and 23 of 24 KD patients were examined within 48 h. By evaluating the serum NT‐proBNP level in young infants with acute fever, it might be possible to detect KD without waiting for 5 days or emergence of other manifestations associated with KD.…”

Kawasaki Disease in Children Older Than 10 Years: A Clinical Experience From Northwest India

“…Use of 128slice dual source computed tomography coronary angiography (CTCA) was initiated in 2014, and this imaging modality has been performed in select patients who had large or unusual CAAs, or where the visualization of coronaries was difficult because of a thick chest wall (10). Assay of serum N-terminal probrain natriuretic peptide (NT-proBNP) levels was initiated in our laboratory in 2014 (11).…”

Diagnosis of Kawasaki disease

“…NT-pro-BNP estimation (a marker of myocardial damage) has recently been evaluated for inclusion in the diagnostic criteria of KD. 58,59 Although NT-pro-BNP is not specific for KD and may be elevated in any disease that leads to myocardial damage, NT-pro-BNP-based diagnostic algorithm has been proposed that scores better than the AHA diagnostic algorithm for incomplete KD. In addition, proteomic studies have identified biomarkers for the diagnosis of KD.…”