Value of amino‐terminal pro B‐natriuretic peptide in diagnosing Kawasaki disease

McNeal-Davidson, Ariane; Fournier, Anne; Spigelblatt, Linda; Saint-Cyr, Claire; Mir, Thomas S.; Nir, Amiram; Dallaire, Frédéric; Cousineau, Jean-Michel; Delvin, Edgard; Dahdah, Nagib

doi:10.1111/j.1442-200x.2012.03609.x

Cited by 33 publications

(58 citation statements)

References 30 publications

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“…The degree of inflammation may have decreased over time. The clinical usefulness of NT-proBNP levels in diagnosing KD has been demonstrated by McNeal-Davidson et al20); however, in their report, the difference in NT-proBNP levels between IVIG non-responders and IVIG responders did not reach statistical significance. In addition, the relative lack of value of TB in predicting IVIG resistance in iKD patients compared with cKD patients in our study may be correlated with more systemic inflammation in cKD patients compared with iKD patients since elevated TB levels probably reflect inflammation of the bile duct 21)…”

Section: Discussionmentioning

confidence: 71%

Clinically Useful Predictors of Resistance to Intravenous Immunoglobulin and Prognosis of Coronary Artery Lesions in Patients with Incomplete Kawasaki Disease

Cho

Kang

2014

Korean Circ J

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Background and ObjectivesThe prevalence of incomplete Kawasaki disease (iKD) is progressively increasing. We aimed to retrospectively investigate the predictors of intravenous immunoglobulin (IVIG) resistance in iKD patients and compare them with those of IVIG resistance in complete Kawasaki disease (cKD) patients. We also compared the prognosis of coronary artery lesions (CALs) between the IVIG non-responders and responders in both iKD and cKD groups.Subjects and MethodsA total of 234 cKD and 77 iKD patients were treated with IVIG between February 2009 and April 2012. Among these 311 patients, we reviewed the data of 77 iKD patients and 75 age-matched cKD patients.ResultsPatients with iKD having an elevated neutrophil count {percentage of segmented neutrophils (SEG%) ≥79.0} were at risk of IVIG resistance, while patients with cKD having SEG% ≥79.25 and serum total bilirubin (TB) ≥0.56 mg/dL were at risk of IVIG resistance as shown by multivariable logistic regression analysis. Fractional changes of laboratory data before and after IVIG treatment showed that Creactive protein (CRP) and N-terminal B type natriuretic peptide (NT-proBNP) levels were significantly elevated in IVIG non-responders of the iKD group, whereas erythrocyte sedimentation rate was significantly elevated in IVIG non-responders of the cKD group. Among the patients who had CALs at 10 months after the start of illness, the z scores of coronary arteries were higher in IVIG non-responders of the iKD group, when compared with IVIG non-responders of the cKD group.ConclusionElevated SEG%, changes in CRP and NT-proBNP levels may help in early detection of IVIG resistance in patients of the iKD group, which may aid in predicting the prognosis of CALs in these patients. Further studies with a larger number of patients are warranted.

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Section: Discussionmentioning

confidence: 71%

Clinically Useful Predictors of Resistance to Intravenous Immunoglobulin and Prognosis of Coronary Artery Lesions in Patients with Incomplete Kawasaki Disease

Cho

Kang

2014

Korean Circ J

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“…9–14 We tested periostin as a possible serum biomarker, because markers of cardiac/vascular injury could be very helpful in differentiating children with KD from children with benign febrile illnesses that do not manifest cardiac pathology. The N-terminal moiety of brain natriuretic peptide (NT-proBNP), a cardiac hormone secreted by ventricular cardiomyocytes in response to stress, may also be useful in this regard.…”

Section: Discussionmentioning

confidence: 99%

Periostin is Upregulated in Coronary Arteriopathy in Kawasaki Disease and is a Potential Diagnostic Biomarker

Reindel

Kim²,

Baker

et al. 2014

Pediatric Infectious Disease Journal

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Periostin was upregulated 11-fold in acute and chronic KD coronary arteries compared with controls (p=0.003). KD patients had significantly elevated serum periostin values compared with febrile controls (p=0.0086). There was no relationship between serum periostin values and age, gender, or acute phase reactants; there was a relationship between serum periostin and maximal coronary artery Z scores that did not reach significance (p=0.08). Periostin may prove to be useful as a component of a future diagnostic biomarker panel for KD.

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“…The N-terminal product of the cleavage reaction that generates B-type natriuretic peptide (NT-proBNP) distinguishes KD from other febrile illnesses, but not well enough to make a clinician confident enough to avoid treatment [51,52]. On this background, use of urine proteomics to identify two proteins, meprin A and filamin C, with very good distinction of KD from non-KD febrile illnesses (AUC 0.98, LR not calculated but with specificity of about 80% at a cut-off value showing 100% sensitivity for KD) represents an important advance with potential to be useful clinically [53••].…”

Section: Kawasaki Diseasementioning

confidence: 99%

Biomarkers in vasculitis

Monach

2014

Current Opinion in Rheumatology

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Purpose of review Better biomarkers are needed for guiding management of patients with vasculitis. Large cohorts and technological advances had led to an increase in pre-clinical studies of potential biomarkers. Recent findings The most interesting markers described recently include a gene expression signature in CD8+ T cells that predicts tendency to relapse or remain relapse-free in ANCA-associated vasculitis, and a pair of urinary proteins that are elevated in Kawasaki disease but not other febrile illnesses. Both of these studies used “omics” technologies to generate and then test hypotheses. More conventional hypothesis-based studies have indicated that the following circulating proteins have potential to improve upon clinically available tests: pentraxin-3 in giant cell arteritis and Takayasu’s arteritis; von Willebrand factor antigen in childhood central nervous system vasculitis; eotaxin-3 and other markers related to eosinophils or Th2 immune responses in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome); and MMP-3, TIMP-1, and CXCL13 in ANCA-associated vasculitis. Summary New markers testable in blood and urine have the potential to assist with diagnosis, staging, assessment of current disease activity, and prognosis. However, the standards for clinical usefulness, in particular the demonstration of either very high sensitivity or very high specificity, have yet to be met for clinically relevant outcomes.

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Value of amino‐terminal pro B‐natriuretic peptide in diagnosing Kawasaki disease

Abstract: NT-proBNP is a reliable marker for the diagnosis of KD. Prospective clinical studies with emphasis on NT-proBNP in a diagnostic algorithm are needed.

Cited by 33 publications

References 30 publications

Clinically Useful Predictors of Resistance to Intravenous Immunoglobulin and Prognosis of Coronary Artery Lesions in Patients with Incomplete Kawasaki Disease

Clinically Useful Predictors of Resistance to Intravenous Immunoglobulin and Prognosis of Coronary Artery Lesions in Patients with Incomplete Kawasaki Disease

Periostin is Upregulated in Coronary Arteriopathy in Kawasaki Disease and is a Potential Diagnostic Biomarker

Biomarkers in vasculitis

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