title: Usefulness of natriuretic peptide for the diagnosis of Kawasaki disease: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To examine the diagnostic value of serum B-type natriuretic peptide (BNP) in acute Kawasaki disease (KD).
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors: College of Medicine, China Medical University, Taichung, Taiwan Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.
authors: Kuan-Ho
authors: KH
authors: Lin
authors: Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Shy-Shin
authors: SS
authors: Chang
authors: Chang Gung University College of Medicine, Taoyuan, Taiwan Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors: Chin-Wei
authors: CW
authors: Yu
authors: Chang Gung University College of Medicine, Taoyuan, Taiwan Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors: Shen-Che
authors: SC
authors: Lin
authors: Chang Gung University College of Medicine, Taoyuan, Taiwan Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors: Shu-Chun
authors: SC
authors: Liu
authors: Chang Gung University College of Medicine, Taoyuan, Taiwan Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors: Hsiao-Yun
authors: HY
authors: Chao
authors: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Meng-Tse Gabriel
authors: http://orcid.org/0000-0002-2648-1522
authors: MT
authors: Lee
authors: Chang Gung University College of Medicine, Taoyuan, Taiwan Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors: Jiunn-Yih
authors: JY
authors: Wu
authors: 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.
authors: Chien-Chang
authors: CC
authors: Lee
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D006801:Humans; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: IMMUNOLOGY