TY - JOUR
T1 - Cardiac Biomarkers Aid in Differentiation of Kawasaki Disease from Multisystem Inflammatory Syndrome in Children Associated with COVID-19
AU - on behalf of the International Kawasaki Disease Registry
AU - Walton, Mollie
AU - Raghuveer, Geetha
AU - Harahsheh, Ashraf
AU - Portman, Michael A.
AU - Lee, Simon
AU - Khoury, Michael
AU - Dahdah, Nagib
AU - Fabi, Marianna
AU - Dionne, Audrey
AU - Harris, Tyler H.
AU - Choueiter, Nadine
AU - Garrido-Garcia, Luis Martin
AU - Jain, Supriya
AU - Dallaire, Frédéric
AU - Misra, Nilanjana
AU - Hicar, Mark D.
AU - Giglia, Therese M.
AU - Truong, Dongngan T.
AU - Tierney, Elif Seda Selamet
AU - Thacker, Deepika
AU - Nowlen, Todd T.
AU - Szmuszkovicz, Jacqueline R.
AU - Norozi, Kambiz
AU - Orr, William B.
AU - Farid, Pedrom
AU - Manlhiot, Cedric
AU - McCrindle, Brian W.
AU - Mohandas, Sindhu
AU - Zadokar, Varsha
AU - Yetman, Anji T.
AU - Yamazaki-Naksahimada, Marco Antonio
AU - Watelle, Laurence
AU - W. Lowndes, Robert
AU - Venkataraman, Aishwarya
AU - Tremoulet, Adriana H.
AU - Vázquez, Belén Toral
AU - Sundaram, Balasubramanian
AU - Shah, Ashish
AU - Sehgal, Anupam
AU - Sabati, Arash A.
AU - Ravi, Prasad
AU - Prasad, Deepa
AU - Pagano, Joseph J.
AU - Mondal, Tapas
AU - Merves, Shae A.
AU - McHugh, Kimberly E.
AU - Mauriello, Daniel
AU - Lanari, Marcello
AU - Kutty, Shelby
AU - Khare, Manaswitha
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023.
PY - 2025/1
Y1 - 2025/1
N2 - Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show clinical overlap and both lack definitive diagnostic testing, making differentiation challenging. We sought to determine how cardiac biomarkers might differentiate KD from MIS-C. The International Kawasaki Disease Registry enrolled contemporaneous KD and MIS-C pediatric patients from 42 sites from January 2020 through June 2022. The study population included 118 KD patients who met American Heart Association KD criteria and compared them to 946 MIS-C patients who met 2020 Centers for Disease Control and Prevention case definition. All included patients had at least one measurement of amino-terminal prohormone brain natriuretic peptide (NTproBNP) or cardiac troponin I (TnI), and echocardiography. Regression analyses were used to determine associations between cardiac biomarker levels, diagnosis, and cardiac involvement. Higher NTproBNP (≥ 1500 ng/L) and TnI (≥ 20 ng/L) at presentation were associated with MIS-C versus KD with specificity of 77 and 89%, respectively. Higher biomarker levels were associated with shock and intensive care unit admission; higher NTproBNP was associated with longer hospital length of stay. Lower left ventricular ejection fraction, more pronounced for MIS-C, was also associated with higher biomarker levels. Coronary artery involvement was not associated with either biomarker. Higher NTproBNP and TnI levels are suggestive of MIS-C versus KD and may be clinically useful in their differentiation. Consideration might be given to their inclusion in the routine evaluation of both conditions.
AB - Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show clinical overlap and both lack definitive diagnostic testing, making differentiation challenging. We sought to determine how cardiac biomarkers might differentiate KD from MIS-C. The International Kawasaki Disease Registry enrolled contemporaneous KD and MIS-C pediatric patients from 42 sites from January 2020 through June 2022. The study population included 118 KD patients who met American Heart Association KD criteria and compared them to 946 MIS-C patients who met 2020 Centers for Disease Control and Prevention case definition. All included patients had at least one measurement of amino-terminal prohormone brain natriuretic peptide (NTproBNP) or cardiac troponin I (TnI), and echocardiography. Regression analyses were used to determine associations between cardiac biomarker levels, diagnosis, and cardiac involvement. Higher NTproBNP (≥ 1500 ng/L) and TnI (≥ 20 ng/L) at presentation were associated with MIS-C versus KD with specificity of 77 and 89%, respectively. Higher biomarker levels were associated with shock and intensive care unit admission; higher NTproBNP was associated with longer hospital length of stay. Lower left ventricular ejection fraction, more pronounced for MIS-C, was also associated with higher biomarker levels. Coronary artery involvement was not associated with either biomarker. Higher NTproBNP and TnI levels are suggestive of MIS-C versus KD and may be clinically useful in their differentiation. Consideration might be given to their inclusion in the routine evaluation of both conditions.
KW - Amino-terminal prohormone brain natriuretic peptide (NTproBNP)
KW - Cardiac biomarkers
KW - Kawasaki disease (KD)
KW - Multisystem Inflammatory Syndrome in Children (MIS-C)
KW - Troponin I (TnI)
UR - https://www.scopus.com/pages/publications/85180861344
U2 - 10.1007/s00246-023-03338-z
DO - 10.1007/s00246-023-03338-z
M3 - Article
C2 - 38157048
AN - SCOPUS:85180861344
SN - 0172-0643
VL - 46
SP - 116
EP - 126
JO - Pediatric Cardiology
JF - Pediatric Cardiology
IS - 1
M1 - 370569
ER -