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Objectives <p>To study the diagnostic performance of pro-brain natriuretic peptide (Pro-BNP) and N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) levels in diagnosing Kawasaki disease (KD), including incomplete forms, in a developing country setting.</p> Methods <p>In this cross-sectional study, levels of Pro-BNP and NT-pro-BNP were compared between 37 cases with KD, as defined by American Heart Association and 37 controls (age- and gender-matched children with acute febrile illness). Echocardiogram and biochemical estimation of the above markers were performed in children with KD before administration of intravenous immunoglobulin. The same markers were estimated in controls at diagnosis. Receiver operating curve (ROC) was plotted to derive diagnostic cutoff of biomarkers in children with KD.</p> Results <p>The median (IQR) age of the study population was 30 (18, 48)&#xa0;months. Incomplete KD was observed in 17 (46%) children. The most common illness in controls was scrub typhus (<i>n</i> = 11; 27%). Seventeen (46%) children with KD had coronary artery aneurysm. Levels of biomarkers were higher in cases compared to controls [Pro-BNP: 4690 (3579, 5726) vs 475 (72, 666)&#xa0;pg/mL, <i>P</i> &lt; 0.001; and NT-pro-BNP: 901 (802, 1037) vs. 84 (25,97)&#xa0;pg/mL, <i>P</i> &lt; 0.001)]. A cutoff of 2899&#xa0;pg/mL for Pro-BNP and 339&#xa0;pg/mL for NT-pro-BNP predicted the diagnosis of KD. Subgroup analysis in 54 children with fever showed false positivity rate of 27% with AHA criteria that reduced to 3% with the addition of Pro-BNP or NT-pro-BNP.</p> Conclusions <p>The levels of Pro-BNP and NT-pro-BNP were significantly higher in children with KD than children with acute febrile illness and had a good diagnostic accuracy for KD.</p>

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Diagnostic Accuracy of Pro-Brain Natriuretic Peptide and N-Terminal-Pro-Brain Natriuretic Peptide in Diagnosing Incomplete Kawasaki Disease

  • 期刊论文

  • 发表日期：

    2025年10月13日

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  • John Emmanuel,
  • Jaikumar Govindaswamy Ramamoorthy,
  • Avinash Anantharaj,
  • Ramesh Ramasamy

摘要

Objectives

To study the diagnostic performance of pro-brain natriuretic peptide (Pro-BNP) and N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) levels in diagnosing Kawasaki disease (KD), including incomplete forms, in a developing country setting.

Methods

In this cross-sectional study, levels of Pro-BNP and NT-pro-BNP were compared between 37 cases with KD, as defined by American Heart Association and 37 controls (age- and gender-matched children with acute febrile illness). Echocardiogram and biochemical estimation of the above markers were performed in children with KD before administration of intravenous immunoglobulin. The same markers were estimated in controls at diagnosis. Receiver operating curve (ROC) was plotted to derive diagnostic cutoff of biomarkers in children with KD.

Results

The median (IQR) age of the study population was 30 (18, 48) months. Incomplete KD was observed in 17 (46%) children. The most common illness in controls was scrub typhus (n = 11; 27%). Seventeen (46%) children with KD had coronary artery aneurysm. Levels of biomarkers were higher in cases compared to controls [Pro-BNP: 4690 (3579, 5726) vs 475 (72, 666) pg/mL, P < 0.001; and NT-pro-BNP: 901 (802, 1037) vs. 84 (25,97) pg/mL, P < 0.001)]. A cutoff of 2899 pg/mL for Pro-BNP and 339 pg/mL for NT-pro-BNP predicted the diagnosis of KD. Subgroup analysis in 54 children with fever showed false positivity rate of 27% with AHA criteria that reduced to 3% with the addition of Pro-BNP or NT-pro-BNP.

Conclusions

The levels of Pro-BNP and NT-pro-BNP were significantly higher in children with KD than children with acute febrile illness and had a good diagnostic accuracy for KD.