The Importance of Serum N-Terminal Pro-Brain Natriuretic Peptide and Endogenous Hydrogen Sulfide for Predicting Coronary Artery Lesions in Pediatric Kawasaki Disease Patients: Findings From a Tertiary Care Hospital in Karachi, Pakistan

Abstract

Introduction Kawasaki disease (KD) is an idiopathic, acute systemic vasculitis typically affecting medium-sized blood vessels with an inclination towards the coronary arteries. There is no specific diagnostic test established for it yet. Hence, our study aims to evaluate serum N-terminal pro-brain natriuretic peptide (NT-proBNP), hydrogen sulfide (H 2 S), and interleukin-6 (IL-6) levels as potential diagnostic tools in children with KD and determine its relationship with the development of coronary artery lesions (CAL) in the pediatric population visiting a tertiary care hospital in Karachi. Methods A prospective observational study was performed on a sample of 500 children at a tertiary care hospital over a period of two years from June 2017 to June 2019. Blood samples were collected from two groups labeled CAL and non-coronary artery lesion (NCAL), and different biomarkers including NT-proBNP, IL-6, and H 2 S were compared between them to predict the diagnostic properties of each marker. Results Among the 500 children, 50% were between the age of one to five years. All presented with fever and varying degrees of associated symptoms. On lab investigations, levels of NT-proBNP and IL-6 during the acute phase of the disease were found to be higher in the CAL group than the NCAL and control groups (p<0.001). However, H 2 S levels during the acute attack were significantly lower in the CAL group when compared to the NCAL or control groups (p<0.001). Conclusion Elevated levels of NT-proBNP and IL-6 can be utilized as potential clinical markers for identifying children at risk of developing CAL as a complication of KD. Reduced H 2 S levels are also proposed as an indicator of progress towards CAL and should be considered in reaching a diagnosis.

Low-Dose Methylprednisolone Therapy for Intravenous Immunoglobulin-Resistant&nbsp;Kawasaki Disease

“…The report has showed that increased BNP predicts the risk of CAL in KD [9,10]. In our study, we found the level of BNP was signi cantly increased in CAL group of IVIG + IVMP group.…”

“…Studys have showed that brain natriuretic peptide (BNP) play a signi cant role in the pathogenesis of KD [8], and predicts the risk of CAL in Kawasaki disease [9,10]. In this study, we detected the level of BNP in IVIG + IVMP group with CAL and without CAL.…”