N-terminal Pro-Brain Natriuretic Peptide (NT proBNP) as a Predictive Indicator of Initial Intravenous Immunoglobulin Treatment Failure in Children With Kawasaki Disease: A Retrospective Study

BACKGROUND Randomized controlled trials previously provided different conclusions about the superiority of adding corticosteroids to initial intravenous immunoglobulin treatment for the prevention of coronary artery abnormalities in patients with Kawasaki disease (KD). To further assess this issue, we analyzed large‐scale data from nationwide KD surveys in Japan, where combination treatment (corticosteroids added to initial standard intravenous immunoglobulin treatment) has become commonly used for patients at high risk for KD. METHODS AND RESULTS Standard intravenous immunoglobulin treatment and combination treatment were compared using data from time periods with and without combination treatment. Outcome measures were coronary artery abnormalities and initial intravenous immunoglobulin treatment failure. Hospitals where ≥20% of patients received combination treatment were identified, and treatment and control groups were selected via matching by age, sex, illness day at initial treatment, and KD recurrence. Matched group selection and subsequent analyses were conducted 1000 times to minimize sampling bias and potential confounders (bootstrapping). From 115 hospitals, 1593 patients with KD in the treatment group and 1593 controls were selected for each of the 1000 sample iterations. The median proportion of patients who developed coronary artery abnormalities among the treatment group and controls were 4.6% (95% CI, 3.8%–5.8%) and 8.8% (95% CI, 7.5%–10.0%), respectively: an estimated risk ratio of 0.53 (0.41–0.67). A median of 14.1% (95% CI, 12.4%–15.9%) of the patients in the treatment group and 21.7% (95% CI, 19.8%–23.4%) in the controls had treatment failure: an estimated risk ratio of 0.65 (0.56―0.75). CONCLUSIONS Combination treatment reduced coronary artery abnormality risk by an estimated 47% and treatment failure by 35%. Multiple‐dose corticosteroids may provide benefit in selected patients at high risk for KD.

Download Full-text

The relationship of eosinophilia to intravenous immunoglobulin treatment failure in Kawasaki disease

Pediatric Allergy and Immunology ◽

10.1111/j.1399-3038.2007.00516.x ◽

2007 ◽

Vol 18 (4) ◽

pp. 354-359 ◽

Cited By ~ 80

Author(s):

Ho-Chang Kuo ◽

Kuender D. Yang ◽

Chi-Di Liang ◽

Chin-Nam Bong ◽

Hong-Ren Yu ◽

...

Keyword(s):

Kawasaki Disease ◽

Treatment Failure ◽

Intravenous Immunoglobulin ◽

Immunoglobulin Treatment ◽

Relationship Of ◽

The Relationship

Download Full-text

N-terminal pro-brain natriuretic peptide in acute Kawasaki disease correlates with coronary artery involvement

Cardiology in the Young ◽

10.1017/s1047951114002431 ◽

2014 ◽

Vol 25 (7) ◽

pp. 1311-1318 ◽

Cited By ~ 9

Author(s):

Philippe M. Adjagba ◽

Laurent Desjardins ◽

Anne Fournier ◽

Linda Spigelblatt ◽

Martine Montigny ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Brain Natriuretic Peptide ◽

Intravenous Immunoglobulin ◽

Natriuretic Peptide ◽

Brain Natriuretic Peptide Level ◽

Z Score ◽

Natriuretic Peptide Level ◽

Coronary Artery Dilatation ◽

Peptide Level

AbstractBackgroundWe have lately documented the importance of N-terminal pro-brain natriuretic peptide in aiding the diagnosis of Kawasaki disease.ObjectivesWe sought to investigate the potential value of N-terminal pro-brain natriuretic peptide pertaining to the prediction of coronary artery dilatation (Z-score>2.5) and/or of resistance to intravenous immunoglobulin therapy. We hypothesised that increased serum N-terminal pro-brain natriuretic peptide level correlates with increased coronary artery dilatation and/or resistance to intravenous immunoglobulin.MethodsWe carried out a prospective study involving newly diagnosed patients treated with 2 g/kg intravenous immunoglobulin within 5–10 days of onset of fever. Echocardiography was performed in all patients at onset, then weekly for 3 weeks, then at month 2, and month 3. Coronary arteries were measured at each visit, and coronary artery Z-score was calculated. All the patients had N-terminal pro-brain natriuretic peptide serum level measured at onset, and the Z-score calculated.ResultsThere were 109 patients enrolled at 6.58±2.82 days of fever, age 3.79±2.92 years. High N-terminal pro-brain natriuretic peptide level was associated with coronary artery dilatation at onset in 22.2 versus 5.6% for normal N-terminal pro-brain natriuretic peptide levels (odds ratio 4.8 [95% confidence interval 1.05–22.4]; p=0.031). This was predictive of cumulative coronary artery dilatation for the first 3 months (p=0.04–0.02), but not during convalescence at 2–3 months (odds ratio 1.28 [95% confidence interval 0.23–7.3]; p=non-significant). Elevated N-terminal pro-brain natriuretic peptide levels did not predict intravenous immunoglobulin resistance, 15.3 versus 13.5% (p=1).ConclusionElevated N-terminal pro-brain natriuretic peptide level correlates with acute coronary artery dilatation in treated Kawasaki disease, but not with intravenous immunoglobulin resistance.

Download Full-text

Serum albumin level predicts initial intravenous immunoglobulin treatment failure in Kawasaki disease

Acta Paediatrica ◽

10.1111/j.1651-2227.2010.01875.x ◽

2010 ◽

Vol 99 (10) ◽

pp. 1578-1583 ◽

Cited By ~ 79

Author(s):

Ho-Chang Kuo ◽

Chi-Di Liang ◽

Chih-Lu Wang ◽

Hong-Ren Yu ◽

Kao-Pin Hwang ◽

...

Keyword(s):

Kawasaki Disease ◽

Serum Albumin ◽

Treatment Failure ◽

Intravenous Immunoglobulin ◽

Serum Albumin Level ◽

Albumin Level ◽

Immunoglobulin Treatment

Download Full-text

The role of age-specific N-terminal pro-brain natriuretic peptide cutoff values in predicting intravenous immunoglobulin resistance in Kawasaki disease: a prospective cohort study

Pediatric Rheumatology ◽

10.1186/s12969-019-0368-8 ◽

2019 ◽

Vol 17 (1) ◽

Author(s):

Shuran Shao ◽

Chunyan Luo ◽

Kaiyu Zhou ◽

Yimin Hua ◽

Mei Wu ◽

...

Keyword(s):

Cohort Study ◽

Kawasaki Disease ◽

Brain Natriuretic Peptide ◽

Intravenous Immunoglobulin ◽

Natriuretic Peptide ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Ivig Resistance ◽

Cutoff Values ◽

Response Group

Abstract Background The prediction of resistance to intravenous immunoglobulins (IVIG) is currently still one of the main research areas in Kawasaki disease (KD). Several studies have reported on the use of N-terminal pro-brain natriuretic peptide (NT-ProBNP) to this end. However, considering the age-dependency of NT-ProBNP levels, age- specific NT-ProBNP cutoff levels to predict IVIG resistance in KD might be more precise and should be evaluated. Methods A prospective cohort study with standardized data collection involving 393 KD patients aged 1 month to 125 months was conducted between June 2015 and April 2018. The demographic characteristics, clinical manifestations and laboratory data were compared between the patients responding to initial intravenous immunoglobulin (IVIG-response group) and those who did not (IVIG-resistance group). We further distinguished four subgroups according to patients’ age (< 1 year, 1–2 years, 2–6 years, > 6 years). The cutoff values of NT-ProBNP for the prediction of IVIG resistance overall and in the subgroups were obtained using receiver operating characteristic (ROC) analysis. Results In all KD patients, the level of NT-ProBNP was significantly higher in the IVIG-resistance compared to the IVIG-response group (P = 0.006). This findings was similar in the subgroups except for patients older than six years. The best cutoff values of NT-ProBNP to predict IVIG resistance were 3755 pg/ml for all KD patients, 3710 pg/ml, 2800 pg/ml, 2480 pg/ml for those aged 2–6 years, 1–2 years and < 1 year, respectively. The corresponding sensitivities were 44.0, 52.2, 50.0 and 75.0%, while the specifities were 84.1, 86.3, 77.9 and 71.8%, respectively. Conclusions NT-proBNP is a complementary laboratory marker for the prediction of IVIG resistance in KD patients, particularly for those younger than one year. Applying age-specific cutoff values is more precise than one value for all ages.

Download Full-text