title: N-terminal pro-B-type natriuretic peptide diagnostic algorithm versus American Heart Association algorithm for Kawasaki disease.
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).
  
  
  CONCLUSIONS
  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.
authors: Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada.
authors: Audrey
authors: A
authors: Dionne
authors: Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada.
authors: Léamarie
authors: L
authors: Meloche-Dumas
authors: Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada.|Division of Pediatrics, Laval University Hospital, Quebec, Canada.
authors: Laurent
authors: L
authors: Desjardins
authors: Division of Pediatrics, Saint Justine University Hospital Center, Montreal, Canada.
authors: Jean
authors: J
authors: Turgeon
authors: Division of Pediatric Rheumatology, Saint Justine University Hospital Center, Montreal, Canada.
authors: Claire
authors: C
authors: Saint-Cyr
authors: Division of Pediatric Infectious Disease, Saint Justine University Hospital Center, Montreal, Canada.
authors: Julie
authors: J
authors: Autmizguine
authors: Division of Pediatrics, Maisonneuve-Rosemont Hospital, Montreal, Canada.
authors: Linda
authors: L
authors: Spigelblatt
authors: Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada.
authors: Anne
authors: A
authors: Fournier
authors: Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada.
authors: Nagib
authors: N
authors: Dahdah
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000572:American Heart Association; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making / Q000379:methods*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012189:Retrospective Studies; D014481:United States
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Kawasaki disease; aminoterminal pro-B-type natriuretic peptide; coronary aneurysm; heart disease; pediatrics