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A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance

Kawasaki disease (KD) is an inflammatory febrile illness of early childhood and the primary cause of acquired heart disease during childhood. Coronary artery aneurysms (CAA) are a serious complication of KD, leading to ischemic heart disease, myocardial infarction, and sudden cardiac death. Timely d...

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Autores principales: Dionne, Audrey, Dahdah, Nagib
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210997/
https://www.ncbi.nlm.nih.gov/pubmed/30322059
http://dx.doi.org/10.3390/children5100141
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author Dionne, Audrey
Dahdah, Nagib
author_facet Dionne, Audrey
Dahdah, Nagib
author_sort Dionne, Audrey
collection PubMed
description Kawasaki disease (KD) is an inflammatory febrile illness of early childhood and the primary cause of acquired heart disease during childhood. Coronary artery aneurysms (CAA) are a serious complication of KD, leading to ischemic heart disease, myocardial infarction, and sudden cardiac death. Timely diagnosis in the first ten days of fever is crucial to reduce the risk of coronary artery complications. Nitrogen-terminal B-type natriuretic peptide (NT-proBNP), originally used for the management of adults with heart disease, was shown to be useful in the diagnosis and management of patients with KD. NT-proBNP is released by cardiomyocytes in response to mechanical factors such as the dilation of cardiac chambers, and to pro-inflammatory cytokines. The utility of NT-proBNP as a biological marker in KD is based on the universal myocardial inflammatory component early in the course of the disease. Patients with KD have higher NT-proBNP at the time of diagnosis than febrile controls, with a pooled sensitivity of 89% (95% confidence interval 78–95), and a specificity of 72% (95% confidence interval 58–82). The positive likelihood ratio is 3.2:1 (95% confidence interval 2.1–4.8). Moreover, patients with resistance to intravenous immunoglobulin treatment and CAA were found to have higher levels of NT-proBNP, suggesting a prognostic role. Nevertheless, the non-specificity of NT-proBNP to KD limits its use as a stand-alone test. In this light, a tentative associative retrospective diagnostic algorithm was highly reliable for including all cases at risk of CAA, which warrants further prospective studies for a better diagnostic index of suspicion and risk stratification of patients.
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spelling pubmed-62109972018-11-05 A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance Dionne, Audrey Dahdah, Nagib Children (Basel) Review Kawasaki disease (KD) is an inflammatory febrile illness of early childhood and the primary cause of acquired heart disease during childhood. Coronary artery aneurysms (CAA) are a serious complication of KD, leading to ischemic heart disease, myocardial infarction, and sudden cardiac death. Timely diagnosis in the first ten days of fever is crucial to reduce the risk of coronary artery complications. Nitrogen-terminal B-type natriuretic peptide (NT-proBNP), originally used for the management of adults with heart disease, was shown to be useful in the diagnosis and management of patients with KD. NT-proBNP is released by cardiomyocytes in response to mechanical factors such as the dilation of cardiac chambers, and to pro-inflammatory cytokines. The utility of NT-proBNP as a biological marker in KD is based on the universal myocardial inflammatory component early in the course of the disease. Patients with KD have higher NT-proBNP at the time of diagnosis than febrile controls, with a pooled sensitivity of 89% (95% confidence interval 78–95), and a specificity of 72% (95% confidence interval 58–82). The positive likelihood ratio is 3.2:1 (95% confidence interval 2.1–4.8). Moreover, patients with resistance to intravenous immunoglobulin treatment and CAA were found to have higher levels of NT-proBNP, suggesting a prognostic role. Nevertheless, the non-specificity of NT-proBNP to KD limits its use as a stand-alone test. In this light, a tentative associative retrospective diagnostic algorithm was highly reliable for including all cases at risk of CAA, which warrants further prospective studies for a better diagnostic index of suspicion and risk stratification of patients. MDPI 2018-10-12 /pmc/articles/PMC6210997/ /pubmed/30322059 http://dx.doi.org/10.3390/children5100141 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Dionne, Audrey
Dahdah, Nagib
A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance
title A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance
title_full A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance
title_fullStr A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance
title_full_unstemmed A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance
title_short A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance
title_sort decade of nt-probnp in acute kawasaki disease, from physiological response to clinical relevance
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210997/
https://www.ncbi.nlm.nih.gov/pubmed/30322059
http://dx.doi.org/10.3390/children5100141
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