title: Prediction of the risk of coronary arterial lesions in Kawasaki disease by brain natriuretic peptide.
abstract: Kawasaki disease (KD) is an acute systemic vasculitis associated with the development of coronary arterial lesions (CALs) occurring in 3-5% of children treated by intravenous immune globulin (IVIG). However, a considerable number of patients who are not responding to IVIG are at much higher risk. Although studies have explored potential biomarkers to predict patients with KD who are at risk of CAL, no useful single marker exists. We hypothesized that the serum concentrations of the N-terminal moiety of brain natriuretic peptide (NT-proBNP) can be useful to predict CAL. Forty-three children with KD (29 males and 14 females) were enrolled in this study. Despite IVIG, 6 of the 43 patients developed CAL. There were, however, no significant differences in variables between children with CAL and those without CAL: These include age, gender, day of the illness, leukocyte count, and the serum levels of sodium, C-reactive protein, and albumin. The serum NT-proBNP level was significantly higher in children with CAL than those without CAL (2,611 ± 1,699 vs. 1,073 ± 1,427 pg/ml; P = 0.03): the cutoff value of 1,000 pg/ml to predict CAL produced a specificity of 0.68, sensitivity of 0.83, and an odds ratio as high as 10.4. In conclusion, NT-proBNP is increased in KD patients who are developing CAL, and patients with an elevated serum NT-proBNP >1,000 pg/ml have a risk of CAL ~10 times higher than that of patients with a modest increase.
authors.affiliation: Department of Pediatrics, Kansai Medical University, Osaka, Japan. kanekok@hirakata.kmu.ac.jp
authors.forename: Kazunari
authors.initials: K
authors.lastname: Kaneko
authors.forename: Ken
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ohashi
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kimata
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Shimo
authors.forename: Shoji
authors.initials: S
authors.lastname: Tsuji
mesh_terms: D015415:Biomarkers / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood; D012372:ROC Curve; D018570:Risk Assessment
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain