1
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Tang X, Guo J, Qi F, Rezaei MJ. Role of non-coding RNAs and exosomal non-coding RNAs in vasculitis: A narrative review. Int J Biol Macromol 2024; 261:129658. [PMID: 38266857 DOI: 10.1016/j.ijbiomac.2024.129658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/26/2024]
Abstract
A category of very uncommon systemic inflammatory blood vessel illnesses known as vasculitides. The pathogenesis and etiology of vasculitis are still poorly known. Despite all of the progress made in understanding the genetics and causes behind vasculitis, there is still more to learn. Epigenetic dysregulation is a significant contributor to immune-mediated illnesses, and epigenetic aberrancies in vasculitis are becoming more widely acknowledged. Less than 2 % of the genome contains protein-encoding DNA. Studies have shown that a variety of RNAs originating from the non-coding genome exist. Long non-coding RNAs (lncRNAs), microRNAs (miRNAs), and circular RNAs (circRNAs) have attracted the most attention in recent years as they are becoming more and more important regulators of different biological processes, such as diseases of the veins. Extracellular vehicles (EVs) such as exosomes, are membrane-bound vesicular structures that break free either during programmed cell death, such as apoptosis, pyroptosis, and necroptosis or during cell activation. Exosomes may be involved in harmful ways in inflammation, procoagulation, autoimmune reactions, endothelial dysfunction/damage, intimal hyperplasia and angiogenesis, all of which may be significant in vasculitis. Herein, we summarized various non-coding RNAs that are involved in vasculitides pathogenesis. Moreover, we highlighted the role of exosomes in vasculitides.
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Affiliation(s)
- Xiuming Tang
- Department of Cardiology, The affiliated hospital to Changchun University of Chinise Medicine, Changchun, Jilin 130021, China.
| | - Jiajuan Guo
- Department of Cardiology, The affiliated hospital to Changchun University of Chinise Medicine, Changchun, Jilin 130021, China
| | - Feng Qi
- Department of Cardiology, The affiliated hospital to Changchun University of Chinise Medicine, Changchun, Jilin 130021, China
| | - Mohammad J Rezaei
- Institute for Immunology and Immune Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
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2
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Walton M, Raghuveer G, Harahsheh A, Portman MA, Lee S, Khoury M, Dahdah N, Fabi M, Dionne A, Harris TH, Choueiter N, Garrido-Garcia LM, Jain S, Dallaire F, Misra N, Hicar MD, Giglia TM, Truong DT, Tierney ESS, Thacker D, Nowlen TT, Szmuszkovicz JR, Norozi K, Orr WB, Farid P, Manlhiot C, McCrindle BW. Cardiac Biomarkers Aid in Differentiation of Kawasaki Disease from Multisystem Inflammatory Syndrome in Children Associated with COVID-19. Pediatr Cardiol 2023:10.1007/s00246-023-03338-z. [PMID: 38157048 PMCID: PMC11213824 DOI: 10.1007/s00246-023-03338-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/25/2023] [Indexed: 01/03/2024]
Abstract
Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show clinical overlap and both lack definitive diagnostic testing, making differentiation challenging. We sought to determine how cardiac biomarkers might differentiate KD from MIS-C. The International Kawasaki Disease Registry enrolled contemporaneous KD and MIS-C pediatric patients from 42 sites from January 2020 through June 2022. The study population included 118 KD patients who met American Heart Association KD criteria and compared them to 946 MIS-C patients who met 2020 Centers for Disease Control and Prevention case definition. All included patients had at least one measurement of amino-terminal prohormone brain natriuretic peptide (NTproBNP) or cardiac troponin I (TnI), and echocardiography. Regression analyses were used to determine associations between cardiac biomarker levels, diagnosis, and cardiac involvement. Higher NTproBNP (≥ 1500 ng/L) and TnI (≥ 20 ng/L) at presentation were associated with MIS-C versus KD with specificity of 77 and 89%, respectively. Higher biomarker levels were associated with shock and intensive care unit admission; higher NTproBNP was associated with longer hospital length of stay. Lower left ventricular ejection fraction, more pronounced for MIS-C, was also associated with higher biomarker levels. Coronary artery involvement was not associated with either biomarker. Higher NTproBNP and TnI levels are suggestive of MIS-C versus KD and may be clinically useful in their differentiation. Consideration might be given to their inclusion in the routine evaluation of both conditions.
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Affiliation(s)
- Mollie Walton
- Children's Mercy Hospital, Kansas City, MO, USA.
- Division of Pediatric Cardiology, Ward Family Heart Center, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 61408, USA.
| | | | - Ashraf Harahsheh
- Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | | - Simon Lee
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, QC, Canada
| | - Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Audrey Dionne
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tyler H Harris
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Nadine Choueiter
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Supriya Jain
- New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Frédéric Dallaire
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Nilanjana Misra
- Cohen Children's Medical Center, Northwell Health, Queens, NY, USA
| | - Mark D Hicar
- Jacobs School of Medicine and BioMedical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Dongngan T Truong
- University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
| | - Elif Seda Selamet Tierney
- Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA
| | | | | | | | - Kambiz Norozi
- Department of Pediatrics, Pediatric Cardiology, Western University, London, ON, Canada
| | - William B Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Pedrom Farid
- Department of Pediatrics, The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, ON, Canada
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Congenital Heart Center, Johns Hopkins University, Baltimore, MD, USA
| | - Brian W McCrindle
- Department of Pediatrics, The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, ON, Canada
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3
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Portman MA, Magaret CA, Barnes G, Peters C, Rao A, Rhyne R. An Artificial Intelligence Derived Blood Test to Diagnose Kawasaki Disease. Hosp Pediatr 2023; 13:201-210. [PMID: 36775804 DOI: 10.1542/hpeds.2022-006868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To develop a highly sensitive and specific blood biomarker panel that identifies febrile children with Kawasaki disease (KD). METHODS We tested blood samples from a single-center cohort of KD (n = 50) and control febrile children (n = 100) to develop a biomarker panel from 11 candidates selected by their assay clinical availability. We used machine learning with least absolute shrinkage and selection operator regression to identify 11 blood markers with values incorporated into a model, which provided a binary predictive risk score for KD determined with Youden's index. We further reduced the model using least angle regression. RESULTS Using 10-fold cross-validation with least absolute shrinkage and selection operator regression on these 11 readouts plus patient age resulted in an area under the receiver operating characteristic curve of 0.94 (95% confidence interval [CI]: 0.90-0.98; P <.01). Using Youden's index, which provided an optimal cut off for a binary predictive risk score, 88 of 97 KD-negative patients were diagnosed negative, and 47 of 50 KD-positive patients were positive, yielding a sensitivity of 0.94 (95% CI: 0.87-1.0) and specificity of 0.91 (95% CI: 0.85-0.96). Least angle regression reduced the final panel to 3 biomarkers: C-reactive protein, NT-proB-type natriuretic peptide, and thyroid hormone uptake. The predictive model then provided an area under the receiver operating characteristic curve of 0.92 (95% CI: 0.87-0.96; P <.001) along with sensitivity and specificity at 86% each. CONCLUSIONS Machine learning identified a highly accurate diagnostic model for KD. The reduced model employs 3 biomarkers currently approved by regulatory bodies and performed on platforms commonly used by certified diagnostic laboratories.
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Affiliation(s)
- Michael A Portman
- Seattle Children's Research Institute, and Department of Pediatrics, University of Washington, Seattle, Washington
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4
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Elgormus Y. Biomarkers and their Clinical Applications in Pediatrics. Biomark Med 2022. [DOI: 10.2174/9789815040463122010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Biomarker studies are becoming increasingly interesting for many fields of
medicine. The use of biomarkers in medicine is involved in detecting diseases and
supporting diagnosis and treatment decisions. New research and new discoveries on the
molecular basis of the disease show that there may be a number of promising new
biomarkers for use in daily clinical practice. Clinical trials in children lag behind adult
research both in quality and quantity. The number of biomarkers validated to optimize
pediatric patient management is limited. In the pathogenesis of many diseases, it should
not be extrapolated to the pediatric clinical setting, taking into account that biomarkers
that are effective in adults are clearly different in children and that ontogeny directly
affects disease development and therapeutic response in children. The search for ideal
biomarkers or markers that can make an early and definitive diagnosis in neonatal
sepsis is still ongoing. The ideal biomarker for pediatric diseases should be costeffective,
noninvasive, applicable to pediatric specific diseases, and its results should
correspond to age-related physiological changes. Lactate, troponin and B-type
natriuretic peptide are valuable biomarkers in the evaluation and management of
critically ill children with cardiac disease. Tumor markers in children are biochemical
substances used in the clinical treatment of pediatric tumors and to detect the presence
of cancer (regression or progression). In this chapter, current and brief information
about biomarkers and their clinical applications used in the diagnosis and monitoring of
pediatric diseases is presented.;
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Affiliation(s)
- Yusuf Elgormus
- Medicine Hospital,Department of Pediatric Health and Diseases,Department of Pediatric Health and Diseases, Medicine Hospital, Istanbul, Turkey,Istanbul,Turkey
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5
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Joung J, Oh JS, Yoon JM, Ko KO, Yoo GH, Cheon EJ. A decision tree model for predicting intravenous immunoglobulin resistance and coronary artery involvement in Kawasaki disease. BMC Pediatr 2022; 22:474. [PMID: 35931986 PMCID: PMC9354345 DOI: 10.1186/s12887-022-03533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives This study aims to develop a new algorithm for predicting intravenous immunoglobulin (IVIG) resistance and coronary artery involvement in Kawasaki disease (KD) through decision tree models. Methods Medical records of children hospitalized for KD were analysed retrospectively. We compared the clinical characteristics, and the laboratory data in the groups with IVIG resistance and coronary artery dilatations (CADs) in KD patients. The decision tree models were developed to predict IVIG resistance and CADs. Results A total 896 patients (511 males and 385 females; 1 month-12 years) were eligible. IVIG resistance was identified in 111 (12.3%) patients, and CADs were found in 156 (17.4%). Total bilirubin and nitrogen terminal- pro-brain natriuretic peptide (NT-proBNP) were significantly higher in IVIG resistant group than in IVIG responsive group (0.62 ± 0.8 mg/dL vs 1.38 ± 1.4 mg/dL and 1231 ± 2136 pg/mL vs 2425 ± 4459 mL, respectively, P < 0.01). Also, CADs were more developed in the resistant group (39/111; 14.9% vs. 117/785; 35.1%, P < 0.01). The decision tree for predicting IVIG resistance was classified based on total bilirubin (0.7 mg/mL, 1.46 mg/dL) and NT-proBNP (1561 pg/mL), consisting of two layers and four nodes, with 86.2% training accuracy and 90.5% evaluation accuracy. The Receiver Operating Characteristic (ROC) evaluated the predictive ability of the decision tree, and the area under the curve (AUC) (0.834; 95% confidence interval, 0.675–0.973; P < 0.05) showed relatively higher accuracy. The group with CADs had significantly higher total bilirubin and NT-proBNP levels than the control group (0.64 ± 0.82 mg/dL vs 1.04 ± 1.14 mg/dL and 1192 ± 2049 pg/mL vs 2268 ± 4136 pg/mL, respectively, P < 0.01). The decision trees for predicting CADs were classified into two nodes based on NT-proBNP (789 pg/mL) alone, with 83.5% training accuracy and 90.3% evaluation accuracy. Conclusion A new algorithm decision tree model presents for predicting IVIG resistance and CADs in KD, confirming the usefulness of NT-proBNP as a predictor of KD.
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Affiliation(s)
- Jinwoon Joung
- Department of Pediatrics, Myunggok Medical Research Center, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Korea
| | - Jun Suk Oh
- Department of Pediatrics, Myunggok Medical Research Center, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Korea
| | - Jung Min Yoon
- Department of Pediatrics, Myunggok Medical Research Center, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Korea
| | - Kyung Ok Ko
- Department of Pediatrics, Myunggok Medical Research Center, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Korea
| | - Gyeong Hee Yoo
- Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Sonnchunhyang 6-gil, Dongnam-gu, Cheonan, 31151, Korea
| | - Eun Jung Cheon
- Department of Pediatrics, Myunggok Medical Research Center, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Korea.
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Clerico A, Aimo A, Cantinotti M. High-sensitivity cardiac troponins in pediatric population. Clin Chem Lab Med 2022; 60:18-32. [PMID: 34679265 DOI: 10.1515/cclm-2021-0976] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022]
Abstract
Apparently healthy children often complain of chest pain, especially after physical exercise. Cardiac biomarker levels are often measured, but the clinical relevance of these assays in children is still debated, even when a cardiac disease is present. Coronary artery disease is exceedingly rare in children, but elevated circulating levels of cardiac troponin I (cTnI) and T (cTnT) in an acute setting may help detect heart failure due to an unknown cardiac disorder, or worsening heart failure, particularly in combination with other biomarkers such as B-type natriuretic peptides. However, the interpretation of biomarkers is often challenging, especially when institutions transition from conventional cTn assays to high-sensitivity (hs-cTn) methods, as well demonstrated in the emergency setting for adult patients. From a clinical perspective, the lack of established reference values in the pediatric age is the main problem limiting the use of hs-cTn methods for the diagnosis and managements of cardiac diseases in infants, children and adolescents. This review aims to discuss the possibility to use hs-cTnI and hs-cTnT to detect cardiac disease and to explore age-related differences in biomarker levels in the pediatric age. We start from some analytical and pathophysiological considerations related to hs-cTn assays. Then, after a systematic literature search, we discuss the current evidence and possible limitations of hs-cTn assay as indicators of cardiac disease in the most frequently cardiac disease in pediatric setting.
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Affiliation(s)
- Aldo Clerico
- Fondazione CNR-Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Aimo
- Fondazione CNR-Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
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7
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Muto T, Masuda Y, Nakamura N, Numoto S, Kodama S, Miyamoto R, Miyata K, Hayakawa T, Mori H, Kuroyanagi Y, Akaihata M, Iwayama H, Kurahashi H, Shimomura Y, Nagai T, Hori T, Agata H, Okumura A. Usefulness of brain natriuretic peptide to distinguish Kawasaki disease from cervical lymphadenitis. Pediatr Int 2022; 64:e15050. [PMID: 34739174 DOI: 10.1111/ped.15050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/22/2021] [Accepted: 10/24/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cervical lymphadenitis (CL) cannot be easily distinguished from Kawasaki disease (KD). We therefore explored whether brain natriuretic peptide (BNP) levels are useful in this context. METHODS We retrospectively analyzed 14 children with CL and 177 children with KD. Patients with KD were divided into three groups according to their clinical symptoms at hospitalization - 97 patients had typical KD, 35 had node-first KD (NFKD), and 45 had KD without lymphadenopathy. We reviewed data on clinical and laboratory parameters, including serum BNP levels, at hospitalization together with factors that might distinguish KD from CL. RESULTS Patients with CL were older than those with KD. Serum BNP levels were higher in all the KD groups than in the CL group. Multivariate logistic regression analyses indicated that higher BNP levels were associated with NFKD (odds ratio: 1.12, 95% confidence interval: 1.01-1.25). The receiver operating characteristic curve yielded a BNP cutoff of 18.3 pg/mL, with a sensitivity of 0.680, a specificity of 0.857, and an area under the curve of 0.806 (95% confidence interval: 0.665-0.947). CONCLUSIONS Serum BNP levels can be used to distinguish KD from CL, especially in patients with NFKD.
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Affiliation(s)
- Taichiro Muto
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Yu Masuda
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Nami Nakamura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Shunsuke Kodama
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Ryosuke Miyamoto
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Kenji Miyata
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | | | - Hiromitsu Mori
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | | | - Mitsuko Akaihata
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Hideyuki Iwayama
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | | | | | - Takuhito Nagai
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Toshinori Hori
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Hiroatsu Agata
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
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8
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Wen JX, Bai X, Niu Y, Hu ZD. Diagnostic accuracy of N-terminal pro-brain natriuretic peptide for Kawasaki disease: An updated systematic review and meta-analysis. Int J Clin Pract 2021; 75:e14538. [PMID: 34133819 DOI: 10.1111/ijcp.14538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/14/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the diagnostic accuracy of circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) for Kawasaki disease (KD). METHODS We searched the PubMed, Web of Science and EMBASE databases to identify the eligible studies investigating the diagnostic accuracy of NT-proBNP for KD. The revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2) was used to evaluate the eligible studies' quality. A meta-analysis was performed with the bivariate model and summary receiver operating characteristic (sROC) curve. We also performed subgroup, publication bias and sensitivity analyses. RESULTS We included 12 studies with 2173 KDs and 1909 control. The pooled sensitivity and specificity of eligible studies were 0.80 (95%CI: 0.72-0.86) and 0.81 (95%CI: 0.73-0.88), respectively. The area under sROC curve was 0.88 (95%CI: 0.84-0.90). Patient selection bias and partial verification bias were the major design weakness of the eligible studies. Sensitivity analysis revealed that the results of this meta-analysis were robust. Subgroup analysis revealed that study design, NT-proBNP assay and participants' body temperature were not the source of heterogeneity across all eligible studies. No publication bias was observed. CONCLUSION NT-proBNP has moderate diagnostic accuracy for KD. It cannot be used for ruling in or ruling out KD when used alone.
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Affiliation(s)
- Jian-Xun Wen
- College of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Xue Bai
- College of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Yan Niu
- College of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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9
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Kim SH, Song ES, Yoon S, Eom GH, Kang G, Cho YK. Serum Ferritin as a Diagnostic Biomarker for Kawasaki Disease. Ann Lab Med 2021; 41:318-322. [PMID: 33303717 PMCID: PMC7748097 DOI: 10.3343/alm.2021.41.3.318] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/05/2020] [Accepted: 11/28/2020] [Indexed: 12/19/2022] Open
Abstract
Diagnosis of Kawasaki disease (KD) is occasionally delayed because it is solely based on clinical symptoms. Previous studies have attempted to identify diagnostic biomarkers for KD. Recently, patients with KD were reported to have elevated serum ferritin levels. We investigated the usefulness of the serum ferritin level as a diagnostic biomarker for distinguishing KD from other acute febrile illnesses. Blood samples were obtained from pediatric patients with KD (N=77) and those with other acute febrile illnesses (N=32) between December 2007 and June 2011 for measuring various laboratory parameters, including serum ferritin levels. In patients with KD, laboratory tests were performed at diagnosis and repeated at 2, 14, and 56 days after intravenous immunoglobulin treatment. At the time of diagnosis, serum ferritin levels in patients with KD (188.8 μg/L) were significantly higher than those in patients with other acute febrile illnesses (106.8 μg/L, P=0.003). The serum ferritin cut-off value of 120.8 μg/L effectively distinguished patients with KD from those with other acute febrile illnesses, with a sensitivity and specificity of 74.5% and 83.3%, respectively. Serum ferritin may be a useful biomarker to distinguish KD from other acute febrile illnesses.
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Affiliation(s)
- Sung Hoon Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Eun Song Song
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Somy Yoon
- Department of Pharmacology and Medical Research Center for Gene Regulation, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do, Korea
| | - Gwang Hyeon Eom
- Department of Pharmacology and Medical Research Center for Gene Regulation, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do, Korea
| | - Gaeun Kang
- Division of Clinical Pharmacology, Chonnam National University Hospital, Gwangju, Korea
| | - Young Kuk Cho
- Department of Pediatrics, College of Medicine Chosun University, Gwangju, Korea
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10
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Fukuda S, Kaneta M, Miyake M, Ohya T, Miyakawa K, Iwamoto M, Ito S. A case of multisystem inflammatory syndrome in children in a Japanese boy: with discussion of cytokine profile. Mod Rheumatol Case Rep 2021; 5:442-447. [PMID: 33904379 DOI: 10.1080/24725625.2021.1920140] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
The new disease concept of multisystem inflammatory syndrome in children (MIS-C), which is a systemic inflammatory syndrome with multiple organ involvement after SARS-CoV2 infection, was established in 2020. MIS-C is common in Hispanic and black children in Europe and North America, with few reports in East Asians. A significant portion of patients with MIS-C develop Kawasaki disease (KD)-like symptoms. Therefore, differential diagnosis is challenging, especially in East Asia, where KD is most prevalent. No Japanese cases have been reported in the literatures so far. We report a case of MIS-C in Japan with KD-like symptoms. A 9-year-old Japanese boy, who was infected with SARS-CoV2 1 month previously along with his family, was admitted to our hospital owing to fever for 6 d and erythema mainly in the groyne and pubic area. He also had conjunctivitis, strawberry tongue and diarrhoea. His laboratory findings were as follows: WBC, 12,840/µL (lymphocytes, 4%); CRP, 22.6 mg/dL, pro-calcitonin, 1.8 ng/mL (normal, <0.50 ng/mL); NT pro-BNP, 7627 pg/mL (<125 pg/mL); and troponin T, 0.14 ng/mL (<0.01 ng/mL). His cardiac function was normal. We initially diagnosed him with KD. His fever rapidly resolved with intravenous immunoglobulin (IVIG) and there were no coronary artery lesions. Desquamation of the fingers was observed later. Finally, a history of SARS-COV2 infection, his age, atypical skin rash, elevation of markers of inflammation and heart failure and lymphopenia suggested the diagnosis of MIS-C rather than KD. Differentiation between KD and MIS-C is necessary even in Japan, especially in patients with atypical features of KD.
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Affiliation(s)
- Sayaka Fukuda
- Department of Pediatrics, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Mio Kaneta
- Department of Pediatrics, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Mayuko Miyake
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Takashi Ohya
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kei Miyakawa
- Department of Microbiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Mari Iwamoto
- Department of Pediatrics, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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11
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Bohn MK, Steele S, Hall A, Poonia J, Jung B, Adeli K. Cardiac Biomarkers in Pediatrics: An Undervalued Resource. Clin Chem 2021; 67:947-958. [PMID: 34125147 DOI: 10.1093/clinchem/hvab063] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/22/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The clinical use of common cardiac biomarkers, such as brain natriuretic peptides and troponins, has traditionally been limited to adult populations in the assessment of heart failure and acute coronary syndrome, respectively. While many have discounted the value of these markers in pediatric populations, emerging evidence suggests they may be useful in the diagnosis and prognostication of many cardiac and noncardiac pathologies in neonates, children, and adolescents, and an increasing number of pediatric hospitals are routinely measuring cardiac markers in their clinical practice. CONTENT This review summarizes and critically evaluates the current literature regarding the application of cardiac biomarkers for clinical decision-making in the pediatric population. Main potential clinical indications discussed herein include primary cardiac disease, immune-related conditions, and noncardiac disease. Important diagnostic and interpretative challenges are also described in relation to each potential indication. SUMMARY Despite a general lack of clinical awareness regarding the value of cardiac biomarkers in pediatrics, there is increasing literature to support their application in various contexts. Cardiac biomarkers should be considered an undervalued resource in the pediatric population with potential value in the diagnosis and prognosis of myocarditis, congenital heart disease, and heart failure, as well as in the assessment of severity and cardiac involvement in immune-related and other systemic conditions. While interpretation remains challenging in pediatrics due to the age- and sex-specific dynamics occurring throughout growth and development, this should not prevent their application. Future research should focus on defining evidence-based cut-offs for specific indications using the most up-to-date assays.
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Affiliation(s)
- Mary Kathryn Bohn
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Shannon Steele
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alexandra Hall
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jasmin Poonia
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Benjamin Jung
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Khosrow Adeli
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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12
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Abstract
PURPOSE OF REVIEW Provide the most recent updates on the epidemiology, pathogenesis, and treatment advances in Kawasaki disease. RECENT FINDINGS Treatment advances in complex, IVIG-refractory cases of Kawasaki disease. Multisystem inflammatory syndrome, a newly reported inflammatory condition with Kawasaki-like features and an association with the 2019 Coronavirus (COVID-19). Kawasaki disease (KD) is a rare systemic inflammatory disease that predominately affects children less than 5 years of age. Pathogenesis of KD remains unknown; the leading theory is that an unknown stimulus triggers an immune-mediated inflammatory cascade in a genetically susceptible child. Classic KD is a clinical diagnosis based on set criteria and excluding other similar clinical entities. Patients who do not fulfill complete diagnostic criteria for KD are often referred to as atypical (or incomplete) KD. The most feared complication of KD is coronary artery abnormality development, and patients with atypical KD are also at risk. Administration of intravenous immunoglobulin (IVIG) and aspirin has greatly reduced the incidence of coronary lesions in affected children. Several other immune-modulating therapies have recently been utilized in complex or refractory cases.
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Affiliation(s)
- Eileen Rife
- Louisiana State University, New Orleans, LA, USA.
| | - Abraham Gedalia
- Division of Pediatric Rheumatology, Children's Hospital and LSU Health Sciences Center, 2000 Henry Clay Avenue, New Orleans, LA, 70118, USA.
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13
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Shenoy B, Singh S, Ahmed MZ, Pal P, Balan S, Viswanathan V, Bhattad S, Rao AP, Chaudhuri M, Shastri DD, Soans ST. Indian Academy of Pediatrics Position Paper on Kawasaki Disease. Indian Pediatr 2020. [PMID: 32471961 DOI: 10.1007/s13312-020-2033-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Distinguishing Kawasaki Disease from Febrile Infectious Disease Using Gene Pair Signatures. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6539398. [PMID: 32420360 PMCID: PMC7201505 DOI: 10.1155/2020/6539398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/24/2020] [Indexed: 12/24/2022]
Abstract
Kawasaki disease (KD) is an acute systemic vasculitis of childhood with prolonged fever, and the diagnosis of KD is mainly based on clinical criteria, which is prone to misdiagnosis with other febrile infectious (FI) diseases. Currently, there remain no effective molecular markers for KD diagnosis. In this study, we aimed to use a relative-expression-based method k-TSP and resampling framework to identify robust gene pair signatures to distinguish KD from bacterial and virus febrile infectious diseases. Our study pool consisted of 808 childhood patients from several studies and assigned to three groups, namely, the discovery set (n = 224), validation set-1 (n = 197), and validation set-2 (n = 387). We had identified 60 biologically relevant gene pairs and developed a top-ranked gene pair classifier (TRGP) using the first seven signatures, with the area under the receiver-operating characteristic curves (AUROC) of 0.947 (95% CI, 0.918-0.976), a sensitivity of 0.936 (95% CI, 0.872-0.987), and a specificity of 0.774 (95% CI, 0.705-0.836) in the discovery set. In the validation set-1, the TRGP classifier distinguished KD from FI with AUROC of 0.955 (95% CI, 0.919-0.991), a sensitivity of 0.959 (95% CI, 0.925-0.986), and a specificity of 0.863 (95% CI, 0.764-0.961). In the validation set-2, the predictive performance of classification was with an AUROC of 0.796 (95% CI, 0.747-0.845), a sensitivity of 0.797 (95% CI, 0.720-0.864), and a specificity of 0.661 (95% CI, 0.606-0.717). Our study reveals that gene pair signatures are robust across diverse studies and can be utilized as objective biomarkers to distinguish KD from FI, helping to develop a fast, simple, and effective molecular approach to improve the diagnosis of KD.
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15
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Jindal AK, Pilania RK, Prithvi A, Guleria S, Singh S. Kawasaki disease: characteristics, diagnosis, and unusual presentations. Expert Rev Clin Immunol 2019; 15:1089-1104. [PMID: 31456443 DOI: 10.1080/1744666x.2019.1659726] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Kawasaki disease (KD) is one of the commonest pediatric vasculitides and is associated with a significant risk of development of coronary artery abnormalities if left untreated. Areas covered: In this review, we have highlighted the incomplete and unusual presentations of KD and also emphasize the controversies pertaining to 2D echocardiography in KD. A PubMed search was performed regarding diagnosis and unusual presentations of KD. Expert opinion: Diagnosis of KD is essentially clinical and based on recognition of typical clinical features that may appear sequentially and all signs and symptoms may not be present at one point of time. There is no confirmatory laboratory test for diagnosis of this condition. Further complicating the picture is the fact that incomplete and atypical forms KD may be seen in up to 50% patients. Although 2D echocardiography continues to be the preferred imaging modality for cardiac assessment in patients with KD, it has its limitations.
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Affiliation(s)
- Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Ashwini Prithvi
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Sandesh Guleria
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
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16
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Shao S, Luo C, Zhou K, Hua Y, Wu M, Liu L, Liu X, Wang C. The role of age-specific N-terminal pro-brain natriuretic peptide cutoff values in predicting intravenous immunoglobulin resistance in Kawasaki disease: a prospective cohort study. Pediatr Rheumatol Online J 2019; 17:65. [PMID: 31533770 PMCID: PMC6751871 DOI: 10.1186/s12969-019-0368-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The prediction of resistance to intravenous immunoglobulins (IVIG) is currently still one of the main research areas in Kawasaki disease (KD). Several studies have reported on the use of N-terminal pro-brain natriuretic peptide (NT-ProBNP) to this end. However, considering the age-dependency of NT-ProBNP levels, age- specific NT-ProBNP cutoff levels to predict IVIG resistance in KD might be more precise and should be evaluated. METHODS A prospective cohort study with standardized data collection involving 393 KD patients aged 1 month to 125 months was conducted between June 2015 and April 2018. The demographic characteristics, clinical manifestations and laboratory data were compared between the patients responding to initial intravenous immunoglobulin (IVIG-response group) and those who did not (IVIG-resistance group). We further distinguished four subgroups according to patients' age (< 1 year, 1-2 years, 2-6 years, > 6 years). The cutoff values of NT-ProBNP for the prediction of IVIG resistance overall and in the subgroups were obtained using receiver operating characteristic (ROC) analysis. RESULTS In all KD patients, the level of NT-ProBNP was significantly higher in the IVIG-resistance compared to the IVIG-response group (P = 0.006). This findings was similar in the subgroups except for patients older than six years. The best cutoff values of NT-ProBNP to predict IVIG resistance were 3755 pg/ml for all KD patients, 3710 pg/ml, 2800 pg/ml, 2480 pg/ml for those aged 2-6 years, 1-2 years and < 1 year, respectively. The corresponding sensitivities were 44.0, 52.2, 50.0 and 75.0%, while the specifities were 84.1, 86.3, 77.9 and 71.8%, respectively. CONCLUSIONS NT-proBNP is a complementary laboratory marker for the prediction of IVIG resistance in KD patients, particularly for those younger than one year. Applying age-specific cutoff values is more precise than one value for all ages.
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Affiliation(s)
- Shuran Shao
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The Cardiac development and early intervention unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Chunyan Luo
- 0000 0001 0807 1581grid.13291.38Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Kaiyu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041, Sichuan, China. .,The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Yimin Hua
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The Cardiac development and early intervention unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,0000 0004 0369 313Xgrid.419897.aKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan China ,0000 0001 0807 1581grid.13291.38Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Mei Wu
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The Cardiac development and early intervention unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Lei Liu
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The Cardiac development and early intervention unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Xiaoliang Liu
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The Cardiac development and early intervention unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,0000 0004 0369 313Xgrid.419897.aKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041, Sichuan, China. .,The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
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17
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Rodriguez-Gonzalez M, Perez-Reviriego AA, Castellano-Martinez A, Cascales-Poyatos HM. N-terminal probrain natriuretic peptide as biomarker for diagnosis of Kawasaki disease. Biomark Med 2019; 13:307-323. [PMID: 30900472 DOI: 10.2217/bmm-2018-0324] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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18
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Na JH, Kim S, Eun LY. Utilization of Coronary Artery to Aorta for the Early Detection of Kawasaki Disease. Pediatr Cardiol 2019; 40:461-467. [PMID: 30218119 DOI: 10.1007/s00246-018-1985-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
Abstract
Timely diagnosis of coronary involvement is paramount in Kawasaki disease (KD) as it can be associated with long-term morbidity. However, echocardiographic measurements of coronary artery dilation in KD are inconsistent and not proficient for all abnormal arteries. The purpose of this study was to investigate more valuable indices and determine their sensitivity and specificity for early diagnosis of coronary involvement in KD. We performed this retrospective study in 218 children. All patients underwent laboratory and echocardiographic evaluations upon admission. We measured the size of the left main coronary artery (LMA), left anterior descending coronary artery (LAD), right coronary artery (RCA), and aorta (Ao), and calculated the LMA/Ao, LAD/Ao, and RCA/Ao ratios. We also calculated the cut-off values of each index using receiver operating characteristic curves. LMA, LAD, and RCA measurements did not correlate with white blood cell count, platelet count, erythrocyte sedimentation rate, C-reactive protein level, or brain natriuretic peptide level. The LMA measurement was associated with hemoglobin, hematocrit, and iron saturation. LAD/Ao was correlated with white blood cell and platelet counts (P < 0.05), whereas RCA/Ao was correlated with ferritin level (P < 0.05). The cut-off value of LMA/Ao was 0.2, with a sensitivity of 85% and specificity of 70%. Individual coronary artery/Ao ratios might provide helpful insight for detection of coronary abnormality in KD in the acute phase. Further investigation is essential to clarify prompt early diagnosis of coronary involvement in KD.
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Affiliation(s)
- Ji-Hoon Na
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Sohyun Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Lucy Youngmin Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea.
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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19
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Aljishi FM, Alsinan A, Almadan B, Almokhtar R, Alsinan T. Diagnosing Incomplete Kawasaki Disease. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 6:172-173. [PMID: 30787847 PMCID: PMC6196688 DOI: 10.4103/sjmms.sjmms_166_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Adil Alsinan
- Department of Pediatric, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Bashayer Almadan
- Department of Pediatric, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Reem Almokhtar
- Department of Pediatric, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Tuqa Alsinan
- Medical Student, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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20
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Wang B, Wang LN, Cheng FF, Lv HT, Sun L, Wei DK, Pu Y, Wu J, Hou YY, Wen B, Xu XP, Yan WH. MiR-222-3p in Platelets Serves as a Distinguishing Marker for Early Recognition of Kawasaki Disease. Front Pediatr 2019; 7:237. [PMID: 31316949 PMCID: PMC6611386 DOI: 10.3389/fped.2019.00237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/24/2019] [Indexed: 12/19/2022] Open
Abstract
Kawasaki disease (KD) is an acute vasculitis, which leads to 20% of sufferers developing coronary artery aneurysm in children if not appropriately treated. Therefore, the early diagnosis of KD is essential for alleviating the risk of developing heart disease. MicroRNAs (miRNAs) are a large class of small non-coding RNAs which post-transcriptionally regulate gene expression and have been shown to play critical roles in numerous biological processes and diseases. In this study, we used high-throughput miRNA sequencing and found dozens of miRNAs are highly expressed in platelets. By comparing the miRNA expression profile of platelets of acute KD patients and other febrile patients, miR-222-3p is validated to be significantly upregulated in platelets of acute KD patients. Furthermore, KEGG pathway analysis shows that targets of miR-222-3p are enriched in immune-related signaling pathways. Our study uncovers the potential of miR-222-3p in platelets as biomarker for early diagnosis of Kawasaki disease.
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Affiliation(s)
- Bo Wang
- Internal Medicine-Cardiovascular Department, Children's Hospital of Soochow University, Suzhou, China
| | - Li-Nong Wang
- Internal Medicine-Cardiovascular Department, Children's Hospital of Soochow University, Suzhou, China
| | - Fang-Fang Cheng
- Internal Medicine-Cardiovascular Department, Children's Hospital of Soochow University, Suzhou, China
| | - Hai-Tao Lv
- Internal Medicine-Cardiovascular Department, Children's Hospital of Soochow University, Suzhou, China
| | - Ling Sun
- Internal Medicine-Cardiovascular Department, Children's Hospital of Soochow University, Suzhou, China
| | - Dong-Kai Wei
- QIAGEN (Suzhou) Translational Medicine Co., Ltd., Suzhou, China
| | - Yu Pu
- QIAGEN (Suzhou) Translational Medicine Co., Ltd., Suzhou, China
| | - Jie Wu
- QIAGEN (Suzhou) Translational Medicine Co., Ltd., Suzhou, China
| | - Yuan-Yuan Hou
- QIAGEN (Suzhou) Translational Medicine Co., Ltd., Suzhou, China
| | - Bin Wen
- QIAGEN (Suzhou) Translational Medicine Co., Ltd., Suzhou, China
| | - Xia-Ping Xu
- QIAGEN (Suzhou) Translational Medicine Co., Ltd., Suzhou, China
| | - Wen-Hua Yan
- Internal Medicine-Cardiovascular Department, Children's Hospital of Soochow University, Suzhou, China
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21
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Dionne A, Dahdah N. A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance. CHILDREN-BASEL 2018; 5:children5100141. [PMID: 30322059 PMCID: PMC6210997 DOI: 10.3390/children5100141] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 12/19/2022]
Abstract
Kawasaki disease (KD) is an inflammatory febrile illness of early childhood and the primary cause of acquired heart disease during childhood. Coronary artery aneurysms (CAA) are a serious complication of KD, leading to ischemic heart disease, myocardial infarction, and sudden cardiac death. Timely diagnosis in the first ten days of fever is crucial to reduce the risk of coronary artery complications. Nitrogen-terminal B-type natriuretic peptide (NT-proBNP), originally used for the management of adults with heart disease, was shown to be useful in the diagnosis and management of patients with KD. NT-proBNP is released by cardiomyocytes in response to mechanical factors such as the dilation of cardiac chambers, and to pro-inflammatory cytokines. The utility of NT-proBNP as a biological marker in KD is based on the universal myocardial inflammatory component early in the course of the disease. Patients with KD have higher NT-proBNP at the time of diagnosis than febrile controls, with a pooled sensitivity of 89% (95% confidence interval 78–95), and a specificity of 72% (95% confidence interval 58–82). The positive likelihood ratio is 3.2:1 (95% confidence interval 2.1–4.8). Moreover, patients with resistance to intravenous immunoglobulin treatment and CAA were found to have higher levels of NT-proBNP, suggesting a prognostic role. Nevertheless, the non-specificity of NT-proBNP to KD limits its use as a stand-alone test. In this light, a tentative associative retrospective diagnostic algorithm was highly reliable for including all cases at risk of CAA, which warrants further prospective studies for a better diagnostic index of suspicion and risk stratification of patients.
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Affiliation(s)
- Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
| | - Nagib Dahdah
- Department of cardiology, CHU Sainte-Justine, Montreal University, 3175, Cote Sainte-Catherine, Montréal, QC H3T 1C5, Canada.
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22
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Jung JY, Ham EM, Kwon H, Kwak YH, Kim DK, Lee JH, Jung JH. N-terminal pro-brain natriuretic peptide and prediction of coronary artery dilatation in hyperacute phase of Kawasaki disease. Am J Emerg Med 2018; 37:468-471. [PMID: 29903669 DOI: 10.1016/j.ajem.2018.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/03/2018] [Accepted: 06/08/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Coronary artery dilatation (CAD) is a great concern with Kawasaki disease (KD). This study aimed to investigate the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and CAD in patients with the hyperacute phase (≤4 days of fever) of KD. METHODS Serum NT-proBNP levels were compared between patients with and those without CAD, who underwent transthoracic echocardiography (TTE) within 24 h of the hyperacute phase of KD in the pediatric emergency department (PED). Electronic medical records of patients aged 1 month to 15 years who visited the PED were retrospectively assessed from January 2010 to December 31, 2014. RESULTS One hundred nine patients were enrolled in the study. Twenty-three of those patients had CAD within 24 h of TTE. Median serum NT-proBNP levels were significantly higher in patients with CAD (824.1 pg/ml; interquartile range [IQR], 515.4-1570.0184.8-767.8 pg/ml) than in patients without CAD (396.4 pg/ml; IQR, 184.8-767.8 pg/ml) (p ≤ 0.001). The cutoff value of serum NT-proBNP, which predicted CAD during the hyperacute phase of KD, was 515.4 pg/ml, which yielded sensitivity of 78.26% and specificity of 61.63%. The area under the curve for NT-proBNP for predicting CAD during hyperacute KD was 0.749 (95% CI, 0.642-0.856). CONCLUSION Serum NT-proBNP might be an additional laboratory marker for detecting early CAD during the hyperacute phase of KD in the PED.
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Affiliation(s)
- Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Eun Mi Ham
- Department of Emergency Medicine, Seoul Medical Center, Jungang-gu, Seoul, Republic of Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jin Hee Jung
- Department of Emergency Medicine, Seoul National University Boramae Hospital, Dongjak-gu, Seoul, Republic of Korea
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23
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Choi JE, Kwak Y, Huh JW, Yoo ES, Ryu KH, Sohn S, Hong YM. Differentiation between incomplete Kawasaki disease and secondary hemophagocytic lymphohistiocytosis following Kawasaki disease using N-terminal pro-brain natriuretic peptide. KOREAN JOURNAL OF PEDIATRICS 2018; 61:167-173. [PMID: 29853942 PMCID: PMC5976567 DOI: 10.3345/kjp.2018.61.5.167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 03/13/2018] [Accepted: 03/17/2018] [Indexed: 12/18/2022]
Abstract
Purpose Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome with many causes, including Kawasaki disease (KD). The purpose of this study was to identify the laboratory tests needed to easily differentiate KD with HLH from incomplete KD alone. Methods We performed a retrospective study on patients diagnosed with incomplete KD and incomplete KD with HLH (HLH-KD) between January 2012 and March 2015. We compared 8 secondary HLH patients who were first diagnosed with incomplete KD with all 247 incomplete KD diagnosed patients during the study period. The complete blood count, erythrocyte sedimentation rate, platelet count, and serum total protein, albumin, triglyceride, C-reactive protein, N-terminal pro-brain natriuretic peptide (NT-proBNP), and ferritin levels were compared. Clinical characteristics and echocardiography findings were also compared between the 2 groups. Results The total duration of fever was longer in the HLH-KD group than in the KD group. White blood cell and platelet counts were higher in the KD group. Alanine aminotransferase, ferritin, and coronary artery diameter were increased in the HLH-KD group compared with those in the KD group. The median of NT-proBNP was significantly higher in the HLH-KD group than in the KD group at 889.0 (interquartile range [IQR], 384.5-1792.0) pg/mL vs. 233.0 (IQR, 107.0-544.0) pg/mL. Conclusion The NT-proBNP level may be helpful in distinguishing incomplete KD from KD with HLH. The NT-proBNP level should be determined in KD patients with prolonged fever, in addition to the white blood cell count, platelet count, and ferritin level, to evaluate secondary HLH.
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Affiliation(s)
- Jung Eun Choi
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yujin Kwak
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jung Won Huh
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun-Sun Yoo
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyung-Ha Ryu
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sejung Sohn
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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Kato M, Ayusawa M, Watanabe H, Komori A, Abe Y, Nakamura T, Kamiyama H, Takahashi S. Cardiac function on 3-D speckle tracking imaging and cytokines in Kawasaki disease. Pediatr Int 2018; 60:342-348. [PMID: 29350882 DOI: 10.1111/ped.13521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/28/2017] [Accepted: 01/12/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) tends to rise in acute phase Kawasaki disease (KD), but the cause of NT-proBNP elevation has not been clarified. In a previous study, cardiac function evaluated on 2-D echocardiography (2D-E) such as ejection fraction was normal, but this does not reflect subtle changes in cardiac dysfunction, and hence the association between cardiac function and NT-proBNP elevation is still controversial. The aim of this study was therefore to elucidate the influence of cardiac function on NT-proBNP elevation, by evaluating cardiac function via strain on 3-D speckle tracking imaging (3D-STI), in acute and subacute KD patients. Given that cytokines are also thought to induce NT-proBNP in acute phase KD, serum cytokines and cytokine receptors were measured at the same time. METHODS Laboratory data and echocardiography in 52 KD patients in the acute and subacute phases were reviewed. RESULTS Median NT-proBNP was significantly elevated in the acute phase compared with the subacute phase (356.5 pg/mL; IQR, 145-904 pg/mL vs 103.5 pg/mL; IQR, 59-150 pg/mL, P < 0.01). All cytokines were also significantly elevated in the acute phase compared with the subacute phase. Tumor necrosis factor (TNF)-α, soluble TNF receptor (sTNFR)1, and sTNFR2 concentration were all significantly higher in the acute phase. Indices of cardiac function were not significant different between phases. NT-proBNP in the acute and subacute phases correlated with sTNFR1 (r = 0.63/0.43, P < 0.01), sTNFR2 (r = 0.50/0.31, P < 0.05), and interleukin-6 (r = 0.58/0.43, P < 0.01). NT-proBNP did not correlate with global longitudinal strain (GLS) on 3D-STI. CONCLUSION Although no correlation was seen between NT-proBNP and GLS on 3D-STI, correlations between NT-proBNP and cytokines were clear. NT-proBNP might be a marker of inflammation in KD, but is not a marker of cardiac function.
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Affiliation(s)
- Masataka Kato
- Nihon University School of Medicine, Pediatrics and Child Health, Itabashi, Tokyo, Japan
| | - Mamoru Ayusawa
- Nihon University School of Medicine, Pediatrics and Child Health, Itabashi, Tokyo, Japan
| | - Hirofumi Watanabe
- Nihon University School of Medicine, Pediatrics and Child Health, Itabashi, Tokyo, Japan
| | - Akiko Komori
- Nihon University School of Medicine, Pediatrics and Child Health, Itabashi, Tokyo, Japan
| | - Yuriko Abe
- Nihon University School of Medicine, Pediatrics and Child Health, Itabashi, Tokyo, Japan
| | - Takahiro Nakamura
- Nihon University School of Medicine, Pediatrics and Child Health, Itabashi, Tokyo, Japan
| | - Hiroshi Kamiyama
- Center for Institutional Research and Medical Education, Itabashi, Tokyo, Japan
| | - Shori Takahashi
- Nihon University School of Medicine, Pediatrics and Child Health, Itabashi, Tokyo, Japan
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25
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Choi JE, Kang HW, Hong YM, Sohn S. C-reactive protein and N-terminal pro-brain natriuretic peptide discrepancy: a differentiation of adenoviral pharyngoconjunctival fever from Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2018; 61:12-16. [PMID: 29441107 PMCID: PMC5807985 DOI: 10.3345/kjp.2018.61.1.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 01/25/2023]
Abstract
Purpose To differentiate adenoviral pharyngoconjunctival fever (PCF) from acute Kawasaki disease (KD) using laboratory tests before results of virus-real time polymerase chain reaction and ophthalmologic examination are obtained. Methods Baseline patient characteristics and laboratory measurements were compared between 40 patients with adenovirus infection and 123 patients with KD. Results The patients with adenovirus infection were generally older than those with KD (median: 3.9 years vs. 2 years, P=0.000). White blood cell and, platelet count, and aspartate aminotransferase, alanine aminotransferase, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels showed significant differences between the 2 groups, but the C-reactive protein (CRP) levels did not (6.8±3.0 mg/dL vs. 8.3±5.8 mg/dL, P=0.126). In the adenovirus infection group, the CRP levels were <1, <3, <10, and ≥10 mg/dL in 2 (5%), 3 (7.5%), 30 (75%), and 5 patients (12.5%), respectively. The cutoff NT-proBNP level was 265 pg/mL. Discrepancy was defined as CRP and NT-proBNP levels of ≥3 or <3 mg/dL, and <265 or ≥265 pg/mL, respectively. Among the 35 patients with adenovirus infection whose CRP levels were ≥3 mg/dL, 29 (82.9%) showed a discrepancy. Conversely, of the 103 patients with KD whose CRP levels were ≥3 mg/dL, 83 (80.6%) showed no discrepancy. Between the groups, a significant difference in discrepancy rate was observed (P=0.000). None of the patients with adenovirus infection had CRP and NT-proBNP levels of <3 mg/dL and ≥265 pg/mL, respectively. Conclusion With a sensitivity of 82.9% and a specificity of 80.6%, CRP and NT-proBNP levels may differentiate between adenoviral PCF and acute KD.
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Affiliation(s)
- Jung Eun Choi
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Won Kang
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sejung Sohn
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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Kim MK, Song MS, Kim GB. Factors Predicting Resistance to Intravenous Immunoglobulin Treatment and Coronary Artery Lesion in Patients with Kawasaki Disease: Analysis of the Korean Nationwide Multicenter Survey from 2012 to 2014. Korean Circ J 2017; 48:71-79. [PMID: 29171205 PMCID: PMC5764872 DOI: 10.4070/kcj.2017.0136] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/12/2017] [Accepted: 10/10/2017] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives Approximately 10–15% of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) and have higher risk for coronary artery lesion (CAL). The aim of this study was to identify predictive factors from laboratory findings in patients who do not respond to IVIG treatment and develop CAL from KD. Methods We retrospectively collected nationwide multicenter data from the Korean Society of Kawasaki Disease and included 5,151 patients with KD between 2012 and 2014 from 38 hospitals. Results Among 5,151 patients with KD, 524 patients belonged to the IVIG-resistant group. The patients in the IVIG-resistant group had a significantly higher serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level (1,573.91±3,166.46 vs. 940.62±2,326.10 pg/mL; p<0.001) and a higher percentage of polymorphonuclear neutrophils (PMNs) (70.89±15.75% vs. 62.38±32.94%; p<0.001). Multivariate logistic regression analyses revealed that significantly increased PMN, NT-proBNP, C-reactive protein (CRP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were the predictors of IVIG resistance (p<0.05). Multivariate logistic regression analyses also showed that only CRP was associated with the risk of CAL (p<0.01), while PMN, NT-proBNP, AST, and ALT were not. Conclusions Elevated PMN, serum NT-proBNP, CRP, AST, and ALT levels are significantly associated with IVIG resistance in patients with KD. Moreover, serum CRP is significantly increased in patients with KD with CAL.
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Affiliation(s)
- Min Kyu Kim
- Department of Pediatrics, Good Moonwha Hospital, Busan, Korea
| | - Min Seob Song
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea.
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
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27
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Affiliation(s)
- Audrey Dionne
- Department of Cardiology; Boston Children's Hospital; Boston MA USA
| | - Nagib Dahdah
- Department of Pediatric Cardiology; CHU Sainte-Justine; Montreal QC Canada
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28
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Evaluation of myocardial deformation in patients with Kawasaki disease using speckle-tracking echocardiography during mid-term follow-up. Cardiol Young 2017; 27:1377-1385. [PMID: 28376935 DOI: 10.1017/s1047951117000580] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
UNLABELLED Speckle-tracking echocardiography is a recently developed technique for the evaluation of myocardial deformation or strain. Our objective was to examine strain through a mid-term follow-up of patients with Kawasaki disease. METHODS We explored left ventricular mechanics using speckle-tracking echocardiography in 35 patients with a history of Kawasaki disease at least 6 months after the acute phase. We also included 30 healthy children as controls. Strain data sets were acquired for the quantification of left ventricular global strain, segmental strain, and left ventricular ejection fraction. RESULTS The mean age of our patients was 25.6±15.4 months. At a median follow-up of 57.5 months (16.5-98.2), although both values were in the normal range, the mean left ventricular ejection proportion of patients (57.3%) was a little lower than that of controls (p⩽0.05). Patient strain values at the basal inferoseptal (20.0), basal anterolateral (19.5), apical septal (23.3), and apical inferior (24.0) segments were lower compared with controls. In all, seven patients had coronary aneurysms during follow-up. Kawasaki disease patients with pyuria had lower left ventricular strain at the mid anterior, mid anteroseptal, apical anterior, and apical inferior segments and global longitudinal strain compared with patients with no pyuria (p⩽0.05). CONCLUSION In children with a history of Kawasaki disease, impairment of left ventricular mechanics occurs especially within the left anterior descending artery territories.
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McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation 2017; 135:e927-e999. [PMID: 28356445 DOI: 10.1161/cir.0000000000000484] [Citation(s) in RCA: 2087] [Impact Index Per Article: 298.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and long-term outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances.
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30
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Han JW. The Efficacy and Safety of High-Dose Intravenous Immunoglobulin in the Treatment of Kawasaki Disease: How Can We Predict Resistance to Intravenous Immunoglobulin Treatment of Kawasaki Disease? Korean Circ J 2017; 47:179-181. [PMID: 28382072 PMCID: PMC5378023 DOI: 10.4070/kcj.2017.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/20/2017] [Accepted: 02/24/2017] [Indexed: 01/02/2023] Open
Affiliation(s)
- Ji Whan Han
- Department of Pediatrics, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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31
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Dionne A, Meloche-Dumas L, Desjardins L, Turgeon J, Saint-Cyr C, Autmizguine J, Spigelblatt L, Fournier A, Dahdah N. N-terminal pro-B-type natriuretic peptide diagnostic algorithm versus American Heart Association algorithm for Kawasaki disease. Pediatr Int 2017; 59:265-270. [PMID: 27589358 DOI: 10.1111/ped.13154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/14/2016] [Accepted: 08/26/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diagnosis of Kawasaki disease (KD) can be challenging in the absence of a confirmatory test or pathognomonic finding, especially when clinical criteria are incomplete. We recently proposed serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) as an adjunctive diagnostic test. METHODS We retrospectively tested a new algorithm to help KD diagnosis based on NT-proBNP, coronary artery dilation (CAD) at onset, and abnormal serum albumin or C-reactive protein (CRP). The goal was to assess the performance of the algorithm and compare its performance with that of the 2004 American Heart Association (AHA)/American Academy of Pediatrics (AAP) algorithm. RESULTS The algorithm was tested on 124 KD patients with NT-proBNP measured on admission at the present institutions between 2007 and 2013. Age at diagnosis was 3.4 ± 3.0 years, with a median of five diagnostic criteria; and 55 of the 124 patients (44%) had incomplete KD. CA complications occurred in 64 (52%), with aneurysm in 14 (11%). Using this algorithm, 120/124 (97%) were to be treated, based on high NT-proBNP alone for 79 (64%); on onset CAD for 14 (11%); and on high CRP or low albumin for 27 (22%). Using the AHA/AAP algorithm, 22/47 (47%) of the eligible patients with incomplete KD would not have been referred for treatment, compared with 3/55 (5%) with the NT-proBNP algorithm (P < 0.001). CONCLUSION This NT-proBNP-based algorithm is efficient to identify and treat patients with KD, including those with incomplete KD. This study paves the way for a prospective validation trial of the algorithm.
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Affiliation(s)
- Audrey Dionne
- Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada
| | - Léamarie Meloche-Dumas
- Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada
| | - Laurent Desjardins
- Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada.,Division of Pediatrics, Laval University Hospital, Quebec, Canada
| | - Jean Turgeon
- Division of Pediatrics, Saint Justine University Hospital Center, Montreal, Canada
| | - Claire Saint-Cyr
- Division of Pediatric Rheumatology, Saint Justine University Hospital Center, Montreal, Canada
| | - Julie Autmizguine
- Division of Pediatric Infectious Disease, Saint Justine University Hospital Center, Montreal, Canada
| | - Linda Spigelblatt
- Division of Pediatrics, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada
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32
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Lee HY, Song MS. Predictive factors of resistance to intravenous immunoglobulin and coronary artery lesions in Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2016; 59:477-482. [PMID: 28194213 PMCID: PMC5300912 DOI: 10.3345/kjp.2016.59.12.477] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/14/2016] [Accepted: 10/18/2016] [Indexed: 01/18/2023]
Abstract
Purpose We conducted a study to determine which factors may be useful as predictive markers in identifying Kawasaki disease (KD) patients with a high risk of resistance to intravenous immunoglobulin (IVIG) and developing coronary artery lesions (CAL). Methods We enrolled 287 patients in acute phase of KD at a single center. The demographic, clinical and laboratory data were collected retrospectively. Results There were 34 patients in the IVIG resistant group. The IVIG resistant group had significantly higher serum N-terminal-pro-brain natriuretic protein (NT-proBNP) levels (P<0.01) and polymorphonuclear neutrophil (PMN) percentage (P<0.01) in comparison to the IVIG responders. The results yielded sensitivity (78.8%, 60.6%), specificity (58.2%, 90%) and cutoff value (628.6 pg/mL, 80.3%) of NT-proBNP and PMN respectively, in predicting IVIG resistance. Despite IVIG administration, 13 of the 287 patients developed CAL. The patients in the CAL group had higher NT-proBNP levels (P<0.01) and higher PMN percentage (P<0.01). In these patients, the results yielded sensitivity (73.3%, 56.7%), specificity (67.9%, 88.9%) and cutoff value (853.4 pg/mL, 80.3%) of NT-proBNP and PMN respectively, for predicting CAL. The area under the curve (AUC) for predicting resistance to IVIG was NT-proBNP 0.712, PMN 0.802. The AUC for predicting CAL was NT-proBNP 0.739, and PMN 0.773. Conclusion Serum NT-proBNP levels and PMN percentage were significantly elevated in patients with KD with IVIG resistance and CAL. Thus, they may be useful predicting markers for IVIG resistance and development of CAL in KD patients.
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Affiliation(s)
- Hye Young Lee
- Department of Pediatrics, Good Gang-An Hospital, Busan, Korea
| | - Min Seob Song
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea
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Kwon H, Lee JH, Jung JY, Kwak YH, Kim DK, Jung JH, Chang I, Kim K. N-terminal pro-brain natriuretic peptide can be an adjunctive diagnostic marker of hyper-acute phase of Kawasaki disease. Eur J Pediatr 2016; 175:1997-2003. [PMID: 27798729 DOI: 10.1007/s00431-016-2798-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/15/2016] [Accepted: 10/18/2016] [Indexed: 12/01/2022]
Abstract
UNLABELLED The purpose of this study was to determine whether the serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level could be a useful marker for Kawasaki disease in the pediatric emergency department (PED) and in the presence of fever duration of 4 days or less (hyper-acute phase of Kawasaki disease). Medical records of patients who were 1 month to 15 years old of age and presented at the PED with suspected Kawasaki disease from January 1, 2010, to December 31, 2014, were collected retrospectively. Two hundred thirty-nine patients with a history of fever for 4 days or less were diagnosed with Kawasaki disease, as well as 111 patients with other febrile diseases, and were enrolled. The NT-proBNP level was significantly higher in patients with Kawasaki disease (Kawasaki disease vs. other febrile disease group, 444.8 (189.7-951.5) vs. 153.4 (68.9-287.6) pg/mL; p < 0.001), and a cutoff value of 244.7 pg/mL yielded a sensitivity and specificity of 68.6 and 70.3 %, respectively. The area under the curve of the NT-proBNP for predicting Kawasaki disease was 0.763 (95 % CI 0.712-0.814). CONCLUSION NT-proBNP might be an adjunctive laboratory marker for hyper-acute phase of Kawasaki disease in the PED. What is Known: • N-terminal pro-brain natriuretic peptide level has been reported as a useful marker for diagnosis in patients with the acute phase of Kawasaki disease. • But, in the cases of less than 5 days of fever, the appropriate level of NT-proBNP for differentiating Kawasaki disease in PED has not been yet evaluated. What is New: • NT-proBNP might be an adjunctive laboratory marker for hyper-acute phase of Kawasaki disease.
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Affiliation(s)
- Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jin Hee Lee
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea. .,Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
| | - Do Kyun Kim
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jin Hee Jung
- Department of Emergency Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea
| | - Ikwan Chang
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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34
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Yanagisawa D, Ayusawa M, Kato M, Watanabe H, Komori A, Abe Y, Nakamura T, Kamiyama H, Takahashi S. Factors affecting N-terminal pro-brain natriuretic peptide elevation in the acute phase of Kawasaki disease. Pediatr Int 2016; 58:1105-1111. [PMID: 26991905 DOI: 10.1111/ped.12986] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/16/2016] [Accepted: 03/09/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aim of this study was to investigate the clinical significance and factors that affect N-terminal pro-brain natriuretic peptide (NT-proBNP) elevation in the acute phase of Kawasaki disease (KD) despite the absence of apparent cardiac complications. METHODS The laboratory and echocardiography results of 44 KD patients in the acute and subacute phases were reviewed. RESULTS With preserved cardiac function, median NT-proBNP was significantly elevated in the acute phase compared with the subacute phase (343 pg/mL, IQR, 162-1182 pg/mL vs 98 pg/mL, IQR, 61-205 pg/mL, respectively; P < 0.0001). The respective levels of tumor necrosis factor (TNF)-α, soluble TNF receptor (sTNFR)1, and sTNFR2 were also significantly elevated in the acute phase compared with the subacute phase: TNF-α, 3.3 pg/mL (IQR, 2.6-4.8 pg/mL) versus 2.4 pg/mL (IQR 1.9-4.0 pg/mL; P < 0.01), sTNFR1, 2741 pg/mL (IQR, 2080-3183 pg/mL) versus 976 pg/mL (IQR, 814-1247 pg/mL; P < 0.0001), sTNFR2, 5644 pg/mL (IQR, 4693-7520 pg/mL) versus 3169 pg/mL (IQR, 2132-3878 pg/mL; P < 0.0001). Log-transformed NT-proBNP was correlated with TNF-α (r = 0.29, P = 0.056), sTNFR1 (r = 0.60, P < 0.0001), and sTNFR2 (r = 0.65, P < 0.0001). TNF-α was correlated with sTNFR1 (r = 0.35, P = 0.02) and sTNFR2 (r = 0.51, P < 0.001). CONCLUSION Tumor necrosis factor-α may cause NT-proBNP elevation in the acute phase of KD, and NT-proBNP level may be an indicator of TNF-α activity.
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Affiliation(s)
- Daisuke Yanagisawa
- Department of Pediatrics and Child Health, Nihon University Graduate School of Medicine, Tokyo, Japan
| | - Mamoru Ayusawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Masataka Kato
- Department of Pediatrics and Child Health, Nihon University Graduate School of Medicine, Tokyo, Japan
| | - Hirofumi Watanabe
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Akiko Komori
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Yuriko Abe
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Takahiro Nakamura
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Kamiyama
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.,Division of Medical Education Planning and Development, Nihon University School of Medicine, Tokyo, Japan
| | - Shori Takahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
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35
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Affiliation(s)
- Amit Rawat
- Pediatric Allergy Immunology Unit, Advanced Pediatrics Center, PGIMER, Chandigarh, India.
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Reddy M, Singh S, Rawat A, Sharma A, Suri D, Rohit MK. Pro-brain natriuretic peptide (ProBNP) levels in North Indian children with Kawasaki disease. Rheumatol Int 2016; 36:551-9. [PMID: 26849890 DOI: 10.1007/s00296-016-3430-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/26/2016] [Indexed: 12/20/2022]
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.
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Affiliation(s)
- Mounika Reddy
- Division of Allergy-Immunology, Advanced Pediatrics Centre, Postgraduate Institute of Medical, Education and Research (PGIMER), Chandigarh, India
| | - Surjit Singh
- Division of Allergy-Immunology, Advanced Pediatrics Centre, Postgraduate Institute of Medical, Education and Research (PGIMER), Chandigarh, India.
| | - Amit Rawat
- Division of Allergy-Immunology, Advanced Pediatrics Centre, Postgraduate Institute of Medical, Education and Research (PGIMER), Chandigarh, India
| | - Avinash Sharma
- Division of Allergy-Immunology, Advanced Pediatrics Centre, Postgraduate Institute of Medical, Education and Research (PGIMER), Chandigarh, India
| | - Deepti Suri
- Division of Allergy-Immunology, Advanced Pediatrics Centre, Postgraduate Institute of Medical, Education and Research (PGIMER), Chandigarh, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Mawad W, Abadir S, Fournier A, Bigras JL, Curnier D, Kadem L, Dahdah N. Timing of Dynamic NT-proBNP and hs-cTnT Response to Exercise Challenge in Asymptomatic Children with Moderate Aortic Valve Regurgitation or Moderate Aortic Valve Stenosis. Pediatr Cardiol 2015; 36:1735-41. [PMID: 26123813 DOI: 10.1007/s00246-015-1225-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
Patients with congenital aortic valve stenosis (AVS) can remain asymptomatic but may develop progressive and often underestimated exercise intolerance. The risk of increased left ventricular (LV) wall stress, irreversible myocardial fibrosis and sudden death in untreated patients warrants earlier intervention. The timing for curative therapy for severe AVS is clear, but optimal timing for moderate stenosis (modAS) is unknown. AVS often coexists with aortic regurgitation, which adds a volume overload to an already pressure-overloaded LV, adding an additional challenge to the estimation of disease severity. We investigated the possible value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) upon treadmill exercise challenge in children with asymptomatic modAS versus moderate regurgitation (modAR). The aim was to determine optimal timing of peak biochemical response. Blood samples were obtained at rest, and then at 20, 40 and 60 min after peak exercise comparing modAS and modAR to healthy controls. Exercise performance was equivalent in all groups, with no difference for biomarker levels at rest. The increase in NT-proBNP was significant in modAR at 40 min (99.2 ± 48.6 ng/L; p = 0.04) and 60 min into recovery (100.0 ± 53.7 ng/L; p = 0.01), but not in modAS. The increase in hs-cTnT was significant only at 60 min into recovery for modAS and modAR. NT-proBNP and hs-cTnT following exercise challenge are possible discriminant biomarkers of modAR from modAS and controls at 60 min into recovery despite comparable exercise performance. This offers a promising avenue for future stratification of aortic valve disease and optimal timing of intervention.
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Affiliation(s)
- Wadi Mawad
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Sylvia Abadir
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Jean-Luc Bigras
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Daniel Curnier
- Department of Kinesiology, University of Montréal, Montréal, Canada
| | - Lyes Kadem
- Mechanical and Industrial Engineering Department, Concordia University, Montréal, QC, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
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Tremoulet AH, Dutkowski J, Sato Y, Kanegaye JT, Ling XB, Burns JC. Novel data-mining approach identifies biomarkers for diagnosis of Kawasaki disease. Pediatr Res 2015; 78:547-53. [PMID: 26237629 PMCID: PMC4628575 DOI: 10.1038/pr.2015.137] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/17/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND As Kawasaki disease (KD) shares many clinical features with other more common febrile illnesses and misdiagnosis, leading to a delay in treatment, increases the risk of coronary artery damage, a diagnostic test for KD is urgently needed. We sought to develop a panel of biomarkers that could distinguish between acute KD patients and febrile controls (FC) with sufficient accuracy to be clinically useful. METHODS Plasma samples were collected from three independent cohorts of FC and acute KD patients who met the American Heart Association definition for KD and presented within the first 10 d of fever. The levels of 88 biomarkers associated with inflammation were assessed by Luminex bead technology. Unsupervised clustering followed by supervised clustering using a Random Forest model was used to find a panel of candidate biomarkers. RESULTS A panel of biomarkers commonly available in the hospital laboratory (absolute neutrophil count, erythrocyte sedimentation rate, alanine aminotransferase, γ-glutamyl transferase, concentrations of α-1-antitrypsin, C-reactive protein, and fibrinogen, and platelet count) accurately diagnosed 81-96% of KD patients in a series of three independent cohorts. CONCLUSION After prospective validation, this eight-biomarker panel may improve the recognition of KD.
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Affiliation(s)
- Adriana H. Tremoulet
- Pediatrics, University of California San Diego, La Jolla, California, USA,Rady Children's Hospital San Diego, San Diego, California, USA
| | | | - Yuichiro Sato
- Pediatrics, University of California San Diego, La Jolla, California, USA,Rady Children's Hospital San Diego, San Diego, California, USA
| | - John T. Kanegaye
- Pediatrics, University of California San Diego, La Jolla, California, USA,Rady Children's Hospital San Diego, San Diego, California, USA
| | | | - Jane C. Burns
- Pediatrics, University of California San Diego, La Jolla, California, USA,Rady Children's Hospital San Diego, San Diego, California, USA
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Parthasarathy P, Agarwal A, Chawla K, Tofighi T, Mondal TK. Upcoming biomarkers for the diagnosis of Kawasaki disease: A review. Clin Biochem 2015; 48:1188-94. [DOI: 10.1016/j.clinbiochem.2015.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 02/20/2015] [Accepted: 02/21/2015] [Indexed: 12/31/2022]
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Choi HS, Lee SB, Kwon JH, Kim HS, Sohn S, Hong YM. Uveitis as an important ocular sign to help early diagnosis in Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2015; 58:374-9. [PMID: 26576181 PMCID: PMC4644765 DOI: 10.3345/kjp.2015.58.10.374] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/04/2015] [Accepted: 04/01/2015] [Indexed: 12/20/2022]
Abstract
Purpose Incomplete Kawasaki disease (KD) is frequently associated with delayed diagnosis and treatment. Delayed diagnosis leads to increasing risk of coronary artery aneurysm. Anterior uveitis is an important ocular sign of KD. The purpose of this study was to assess differences in laboratory findings, including echocardiographic measurements, clinical characteristics such as fever duration and treatment responses between KD patients with and those without uveitis. Methods We conducted a prospective study with 110 KD patients from January 2008 to June 2013. The study group (n=32, KD with uveitis) was compared with the control group (n=78, KD without uveitis). Laboratory data were obtained from each patient including complete blood count (CBC), erythrocyte sedimentation rate (ESR), platelet count, and level of alanine aminotransferase, aspartate aminotransferase, serum total protein, albumin, C-reactive protein (CRP), and N-terminal probrain natriuretic peptide (NT-pro BNP). Echocardiographic measurements and intravenous immunoglobulin responses were compared between the two groups. Results The incidence of uveitis was 29.0%. Neutrophil counts and patient age were higher in the uveitis group than in the control group. ESR and CRP level were slightly increased in the uveitis group compared with the control group, but the difference between the two groups was not significant. No significant differences in coronary arterial complication and treatment responses were observed between the two groups. Conclusion Uveitis is an important ocular sign in the diagnosis of incomplete KD. It is significantly associated with patient age and neutrophil count.
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Affiliation(s)
- Han Seul Choi
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seul Bee Lee
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jung Hyun Kwon
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sejung Sohn
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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N-terminal pro-brain natriuretic peptide in acute Kawasaki disease correlates with coronary artery involvement. Cardiol Young 2015; 25:1311-8. [PMID: 25544036 DOI: 10.1017/s1047951114002431] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND We have lately documented the importance of N-terminal pro-brain natriuretic peptide in aiding the diagnosis of Kawasaki disease. OBJECTIVES We sought to investigate the potential value of N-terminal pro-brain natriuretic peptide pertaining to the prediction of coronary artery dilatation (Z-score>2.5) and/or of resistance to intravenous immunoglobulin therapy. We hypothesised that increased serum N-terminal pro-brain natriuretic peptide level correlates with increased coronary artery dilatation and/or resistance to intravenous immunoglobulin. METHODS We carried out a prospective study involving newly diagnosed patients treated with 2 g/kg intravenous immunoglobulin within 5-10 days of onset of fever. Echocardiography was performed in all patients at onset, then weekly for 3 weeks, then at month 2, and month 3. Coronary arteries were measured at each visit, and coronary artery Z-score was calculated. All the patients had N-terminal pro-brain natriuretic peptide serum level measured at onset, and the Z-score calculated. RESULTS There were 109 patients enrolled at 6.58±2.82 days of fever, age 3.79±2.92 years. High N-terminal pro-brain natriuretic peptide level was associated with coronary artery dilatation at onset in 22.2 versus 5.6% for normal N-terminal pro-brain natriuretic peptide levels (odds ratio 4.8 [95% confidence interval 1.05-22.4]; p=0.031). This was predictive of cumulative coronary artery dilatation for the first 3 months (p=0.04-0.02), but not during convalescence at 2-3 months (odds ratio 1.28 [95% confidence interval 0.23-7.3]; p=non-significant). Elevated N-terminal pro-brain natriuretic peptide levels did not predict intravenous immunoglobulin resistance, 15.3 versus 13.5% (p=1). CONCLUSION Elevated N-terminal pro-brain natriuretic peptide level correlates with acute coronary artery dilatation in treated Kawasaki disease, but not with intravenous immunoglobulin resistance.
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Impairment of Left Ventricular Longitudinal Contraction is Associated with Serum Brain Natriuretic Peptide Concentration in Patients with Acute-Phase Kawasaki Disease. Pediatr Cardiol 2015; 36:979-86. [PMID: 25628157 DOI: 10.1007/s00246-015-1108-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
Abstract
It is well known that brain natriuretic peptide (BNP) is elevated in the acute phase of Kawasaki disease (KD). We hypothesized that mitral annular plane systolic excursion (MAPSE) could identify LV dysfunction in the acute phase of KD. Fifty patients with KD were enrolled in this study. BNP sampling and an echocardiographic study were performed just before and after intravenous immunoglobulin administration. MAPSE was measured in M-mode in the apical four-chamber view. The %MAPSE was calculated as the MAPSE measured in the acute phase divided by that measured in the convalescent phase. We compared the acute and the convalescent phases of KD. The values of the MAPSE were significantly reduced (45 out of 50 patients) during the acute phase and immediately recovered in the convalescent phase (10.0 ± 1.9 vs. 12.7 ± 1.9 mm, P < 0.0001). Of the parameters tested, %MAPSE was the only echocardiographic parameter that was associated with Log-BNP. Additionally, %MAPSE had a significant negative correlation with Log-BNP (r = -0.45, P < 0.0039). Longitudinal LV contraction is impaired in the acute phase of KD, but it immediately recovers in the convalescent phase. Measuring the longitudinal LV contractility should be essential for evaluating LV function in the acute phase of KD, and MAPSE is useful for this evaluation.
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Lin KH, Chang SS, Yu CW, Lin SC, Liu SC, Chao HY, Lee MTG, Wu JY, Lee CC. Usefulness of natriuretic peptide for the diagnosis of Kawasaki disease: a systematic review and meta-analysis. BMJ Open 2015; 5:e006703. [PMID: 25872939 PMCID: PMC4401842 DOI: 10.1136/bmjopen-2014-006703] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To examine the diagnostic value of serum B-type natriuretic peptide (BNP) in acute Kawasaki disease (KD). DESIGN Systematic review and meta-analysis. DATA SOURCES A systematic literature search strategy was designed and carried out using MEDLINE, EMBASE and the Cochrane Library from inception to December 2013. We also performed manual screening of the bibliographies of primary studies and review articles, and contacted authors for additional data. STUDY ELIGIBILITY CRITERIA We included all BNP and NT-pro (N-terminal prohormone) BNP assay studies that compared paediatric patients with KD to patients with febrile illness unrelated to KD. We excluded case reports, case series, review articles, editorials, congress abstracts, clinical guidelines and all studies that compared healthy controls. PRIMARY AND SECONDARY OUTCOME MEASURES The performance characteristics of BNP were summarised using forest plots, hierarchical summary receiver operating characteristic (ROC) curves and bivariate random effects models. RESULTS We found six eligible studies including 279 cases of patients with KD and 203 febrile controls. Six studies examined NT-proBNP and one examined BNP. In general, NT-proBNP is a specific and moderately sensitive test for identifying KD. The pooled sensitivity was 0.89 (95% CI 0.78 to 0.95) and the pooled specificity was 0.72 (95% CI 0.58 to 0.82). The area under the summary ROC curve was 0.87 (95% CI 0.83 to 0.89). The positive likelihood ratio (LR+ 3.20, 95% CI 2.10 to 4.80) was sufficiently high to be qualified as a rule-in diagnostic tool in the context of high pre-test probability and compatible clinical symptoms. A high degree of heterogeneity was found using the Cochran Q statistic. CONCLUSIONS Current evidence suggests that NT-proBNP may be used as a diagnostic tool for KD. NT-proBNP has high diagnostic value for identifying KD in patients with protracted undifferentiated febrile illness. Prospective large cohort studies are needed to help determine best cut-off values and further clarify the role of NT-proBNP in the diagnosis process of KD.
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Affiliation(s)
- Kuan-Ho Lin
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shy-Shin Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Wei Yu
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shen-Che Lin
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Chun Liu
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiao-yun Chao
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Meng-tse Gabriel Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiunn-Yih Wu
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
- Department of Epidemiology, Harvard School of Public Health, Boston, USA
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Sotelo-Cruz N. [A review of Kawasaki disease, a perspective from the articles published in Mexico since January 1977 to May 2012]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 83:214-22. [PMID: 23663892 DOI: 10.1016/j.acmx.2013.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 01/23/2013] [Accepted: 02/01/2013] [Indexed: 11/24/2022] Open
Abstract
Kawasaki disease was described in 1967 by Tomisu Kawasaki. It affects children aged between one and 5 years, and it evolves with fever and small vessel vasculitis, which leads to cardiovascular complications, including coronary aneurisms, myocarditis, valve injuries, pericardial effusion and myocardial infarction; eventually involving many others organs. The etiology actually is not well known, as the exactly pathogenic mechanisms; however, now there are important advances. If the clinical signs and symptoms are identify early and the children received treatment with aspirin and intravenous immunoglobulin, the patients evolves without sequels. The Kawasaki disease is an infrequent disease in Mexico.
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Affiliation(s)
- Norberto Sotelo-Cruz
- Departamento de Medicina y Ciencias de la Salud, Universidad de Sonora, Hermosillo, Sonora, México.
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Lee SB, Choi HS, Son S, Hong YM. Cardiac Function in Kawasaki Disease Patients with Respiratory Symptoms. Korean Circ J 2015; 45:317-24. [PMID: 26240586 PMCID: PMC4521110 DOI: 10.4070/kcj.2015.45.4.317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/03/2015] [Accepted: 04/14/2015] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives Respiratory symptoms are often observed in children with Kawasaki disease (KD) during the acute phase. The association of respiratory viruses in children with KD was investigated using multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) and tissue Doppler echocardiography. Subjects and Methods 138 KD patients were included from January 2010 to June 2013. We compared 3 groups (group 1: n=94, KD without respiratory symptoms; group 2: n=44, KD with respiratory symptoms; and group 3: n=50, febrile patients with respiratory symptoms). Laboratory data were obtained from each patient including N-terminal pro-brain natriuretic peptide (NT-proBNP). Echocardiographic measurements were compared between group 1 and group 2. RT-PCR was performed using nasopharyngeal secretion to screen for the presence of 14 viruses in groups 2 and 3. Results The incidence of KD with respiratory symptoms was 31.8%. The duration of fever was significantly longer, and coronary artery diameter was larger in group 2 than in group 1. Tei index was significantly higher and coronary artery diameter larger in group 2 than group 1. Coronary artery diameter, C-reactive protein levels, platelet count, alanine aminotransferase levels, and NT-pro BNP levels were significantly higher and albumin levels lower in group 2 compared with group 3. Conclusion NT-pro BNP was a valuable diagnostic tool in differentiating KD from other febrile viral respiratory infections. Some viruses were more frequently observed in KD patients than in febrile controls. Tei index using tissue Doppler imaging was increased in KD patients with respiratory symptoms.
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Affiliation(s)
- Seul Bee Lee
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Han Seul Choi
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sejung Son
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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Lee SM, Lee JB, Go YB, Song HY, Lee BJ, Kwak JH. Prediction of resistance to standard intravenous immunoglobulin therapy in kawasaki disease. Korean Circ J 2014; 44:415-22. [PMID: 25469144 PMCID: PMC4248614 DOI: 10.4070/kcj.2014.44.6.415] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/01/2014] [Accepted: 09/12/2014] [Indexed: 12/04/2022] Open
Abstract
Background and Objectives Ten to twenty percent of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) treatment. If untreated, approximately 15% to 25% of KD patients have complications. The aim of this study was to find useful predictors of responsiveness to initial IVIG treatment in KD. Subjects and Methods We retrospectively reviewed medical records of 91 children diagnosed with KD at Myong Ji Hospital from March 2012 to April 2014. Before and after (24 hours to 36 hours) IVIG treatment, the following laboratory data were obtained: hemoglobin (Hb) level, white blood cell count, proportion of neutrophil, lymphocyte and eosinophil, platelet count, erythrocyte sedimentation rate (ERS), C-reactive protein (CRP), creatine kinase (CK), creatine kinase MB (CK-MB), and N-terminal pro-brain natriuretic peptide (NT-proBNP). Subjects were then divided into two groups: IVIG-responsive or IVIG-resistant. Results Of 91 patients, 11 (12%) required retreatment. By univariate analysis, before-IVIG laboratory parameters of white blood cell count, % neutrophil, ERS, CRP, sodium, CK, CK-MB, and NT-proBNP were significantly different between IVIG-responsive and IVIG-resistant patient groups. In the after-IVIG laboratory parameters, Hb level, white blood cell count, % neutrophil, % lymphocyte, CRP, CK, CK-MB, and NT-pro-BNP were significantly different between the two groups. While the mean-differences were not statistically significant, fractional change (FC)-CRP and FC-% neutrophil showed significant difference. By multivariate analysis, FC-CRP was confirmed to be an independent predictor for initial IVIG resistance. Conclusion Fractional change-C-reactive protein might be a useful and important value for predicting initial IVIG resistance in KD patients.
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Affiliation(s)
- Sang Min Lee
- Department of Pediatrics, Myongji Hospital, Goyang, Korea
| | - Jeong Bong Lee
- Department of Pediatrics, Myongji Hospital, Goyang, Korea
| | - Young Bin Go
- Department of Pediatrics, Myongji Hospital, Goyang, Korea
| | - Ho Young Song
- Department of Pediatrics, Myongji Hospital, Goyang, Korea
| | - Byung Jin Lee
- Department of Pediatrics, Myongji Hospital, Goyang, Korea
| | - Ji Hee Kwak
- Department of Pediatrics, Myongji Hospital, Goyang, Korea
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Bae HK, Lee DK, Kwon JH, Kim HS, Sohn S, Hong YM. Clinical characteristics and serum N-terminal pro-brain natriuretic peptide as a diagnostic marker of Kawasaki disease in infants younger than 3 months of age. KOREAN JOURNAL OF PEDIATRICS 2014; 57:357-62. [PMID: 25210523 PMCID: PMC4155180 DOI: 10.3345/kjp.2014.57.8.357] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/10/2014] [Accepted: 03/05/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE The incidence of Kawasaki disease (KD) is rare in young infants (less than 3 months of age), who present with only a few symptoms that fulfill the clinical diagnostic criteria. The diagnosis for KD can therefore be delayed, leading to a high risk of cardiac complications. We examined the clinical characteristics and measured the serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels of these patients for assessing its value in the early detection of KD. METHODS We retrospectively reviewed the data of young infants diagnosed with KD from 2004 to 2012. The control group included 20 hospitalized febrile patients. Laboratory data, including NT-proBNP were obtained for each patient in both groups. RESULTS Incomplete KD was observed in 21/24 patients (87.5%). The mean fever duration on admission was 1.36±1.0 days in the KD group. Common symptoms included erythema at the site of Bacille Calmette-Guerin inoculation (70.8%), skin rash (50.0%), changes of oropharyngeal mucosa (29.1%), and cervical lymphadenopathy (20.8%). The mean number of major diagnostic criteria fulfilled was 2.8±1.4. Five KD patients (20.8%) had only one symptom matching these criteria. The incidence of coronary artery complications was 12.5%. The mean serum NT-proBNP level in the acute phase, in the KD and control groups, were 4,159±3,714 pg/mL and 957±902 pg/mL, respectively, which decreased significantly in the convalescent phase. CONCLUSION Incomplete KD was observed in 87.5% patients. Serum NT-proBNP might be a valuable biomarker for the early detection of KD in febrile infants aged <3 months.
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Affiliation(s)
- Hyun Kyung Bae
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Do Kyung Lee
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jung Hyun Kwon
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sejung Sohn
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea. ; Ewha Womans University Global Top 5 Research Program, Seoul, Korea
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Kaneko K, Yoshimura K, Tsuji S. Brain Natriuretic Peptide as a Novel Diagnostic Biomarker in Kawasaki Disease. ACTA ACUST UNITED AC 2014. [DOI: 10.17795/compreped-19505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
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 preclinical 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 antineutrophil cytoplasmic antibody (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 matrix metalloproteinase-3, tissue inhibitor of metalloproteinase-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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Kim SY, Han MY, Cha SH, Jeon YB. 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. Pediatr Cardiol 2014; 34:1837-43. [PMID: 23744100 DOI: 10.1007/s00246-013-0724-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
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.
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Affiliation(s)
- So Youn Kim
- Department of Pediatrics, Kyunghee University School of Medicine, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
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