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Pediatr Int. 2017 Mar;59(3):265-270. doi: 10.1111/ped.13154. Epub 2016 Dec 2.

N-terminal pro-B-type natriuretic peptide diagnostic algorithm versus American Heart Association algorithm for Kawasaki disease.

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Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada.
Division of Pediatrics, Laval University Hospital, Quebec, Canada.
Division of Pediatrics, Saint Justine University Hospital Center, Montreal, Canada.
Division of Pediatric Rheumatology, Saint Justine University Hospital Center, Montreal, Canada.
Division of Pediatric Infectious Disease, Saint Justine University Hospital Center, Montreal, Canada.
Division of Pediatrics, Maisonneuve-Rosemont Hospital, Montreal, Canada.



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.


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.


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).


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.


Kawasaki disease; aminoterminal pro-B-type natriuretic peptide; coronary aneurysm; heart disease; pediatrics

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