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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.

Author information

1
Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada.
2
Division of Pediatrics, Laval University Hospital, Quebec, Canada.
3
Division of Pediatrics, Saint Justine University Hospital Center, Montreal, Canada.
4
Division of Pediatric Rheumatology, Saint Justine University Hospital Center, Montreal, Canada.
5
Division of Pediatric Infectious Disease, Saint Justine University Hospital Center, Montreal, Canada.
6
Division of Pediatrics, Maisonneuve-Rosemont Hospital, Montreal, Canada.

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).

CONCLUSION:

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.

KEYWORDS:

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

PMID:
27589358
DOI:
10.1111/ped.13154
[Indexed for MEDLINE]

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