title: A Comprehensive Assessment of the Value of Laboratory Indices in Diagnosing Kawasaki Disease.
abstract: OBJECTIVE
  Kawasaki disease (KD) is the primary cause of heart disease among children, but because its clinical symptoms are nonspecific, it is difficult to diagnose. The purpose of this study was to evaluate laboratory indices for possible use in the early diagnosis of KD and to determine which indices are predictive of a response to intravenous immunoglobulin (IVIG) and can be used to monitor the effects of treatment.
  
  
  METHODS
  Three hundred thirty KD patients, 330 age-matched children with KD-like febrile disease, and 330 age-matched healthy children (controls) were enrolled in this prospective study. Levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and cytokines were determined in all study subjects.
  
  
  RESULTS
  In the derivation cohort, 181 patients in the KD group were compared with 181 patients in the KD-like febrile group. The following indices were found to be useful in the diagnosis of KD: NT-proBNP (area under the curve [AUC] 0.923), ESR (AUC 0.909), CRP (AUC 0.834), and interleukin-6 (IL-6; AUC 0.678). The diagnostic efficiency of each index demonstrated in the derivation cohort was repeated in the 149 KD patients in the validation cohort. There were significant differences in NT-proBNP levels between IVIG-responsive KD patients (n = 270) and IVIG-nonresponsive KD patients (n = 60), with higher NT-proBNP levels in IVIG-nonresponsive KD patients. The NT-proBNP level can effectively distinguish IVIG-responsive KD patients from IVIG-nonresponsive patients, and its AUC was 0.73. There were also significant differences in the NT-proBNP levels before and after treatment, with a significant decline after treatment.
  
  
  CONCLUSIONS
  Serum levels of NT-proBNP can be used in the diagnosis of KD, the prediction of a patient's sensitivity to IVIG treatment, and the monitoring of the effects of IVIG treatment, but more attention must be paid to the scope of its application.
authors.affiliation: The Children's Hospital of Zhejiang University School of Medicine and Zhejiang Key Laboratory for the Diagnosis and Treatment of Neonatal Diseases, Hangzhou, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Ye
authors.affiliation: Hangzhou First People's Hospital, Hangzhou, China.
authors.forename: Wen-xia
authors.initials: WX
authors.lastname: Shao
authors.affiliation: The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Shi-qiang
authors.initials: SQ
authors.lastname: Shang
authors.affiliation: Zhejiang Chinese Medical University, Hangzhou, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Zhang
authors.affiliation: The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Hu
authors.affiliation: Zhejiang Chinese Medical University, Hangzhou, China.
authors.forename: Chun-chun
authors.initials: CC
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D016207:Cytokines; D016756:Immunoglobulins, Intravenous; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein