Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Predictive factors of resistance to intravenous immunoglobulin and coronary artery lesions in Kawasaki disease

  • Lee, Hye Young (Department of Pediatrics, Good Gang-An Hospital) ;
  • Song, Min Seob (Department of Pediatrics, Inje University Haeundae Paik Hospital)
  • Received : 2016.08.05
  • Accepted : 2016.10.18
  • Published : 2016.12.10
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Abstract

Purpose: We conducted a study to determine which factors may be useful as predictive markers in identifying Kawasaki disease (KD) patients with a high risk of resistance to intravenous immunoglobulin (IVIG) and developing coronary artery lesions (CAL). Methods: We enrolled 287 patients in acute phase of KD at a single center. The demographic, clinical and laboratory data were collected retrospectively. Results: There were 34 patients in the IVIG resistant group. The IVIG resistant group had significantly higher serum N-terminal-pro-brain natriuretic protein (NT-proBNP) levels (P<0.01) and polymorphonuclear neutrophil (PMN) percentage (P<0.01) in comparison to the IVIG responders. The results yielded sensitivity (78.8%, 60.6%), specificity (58.2%, 90%) and cutoff value (628.6 pg/mL, 80.3%) of NT-proBNP and PMN respectively, in predicting IVIG resistance. Despite IVIG administration, 13 of the 287 patients developed CAL. The patients in the CAL group had higher NT-proBNP levels (P<0.01) and higher PMN percentage (P<0.01). In these patients, the results yielded sensitivity (73.3%, 56.7%), specificity (67.9%, 88.9%) and cutoff value (853.4 pg/mL, 80.3%) of NT-proBNP and PMN respectively, for predicting CAL. The area under the curve (AUC) for predicting resistance to IVIG was NT-proBNP 0.712, PMN 0.802. The AUC for predicting CAL was NT-proBNP 0.739, and PMN 0.773. Conclusion: Serum NT-proBNP levels and PMN percentage were significantly elevated in patients with KD with IVIG resistance and CAL. Thus, they may be useful predicting markers for IVIG resistance and development of CAL in KD patients.

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References

  1. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi 1967;16:178-222.
  2. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004;110:2747-71. https://doi.org/10.1161/01.CIR.0000145143.19711.78
  3. Ayusawa M, Sonobe T, Uemura S, Ogawa S, Nakamura Y, Kiyosawa N, et al. Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition). Pediatr Int 2005;47:232-4. https://doi.org/10.1111/j.1442-200x.2005.02033.x
  4. Giannouli G, Tzoumaka-Bakoula C, Kopsidas I, Papadogeorgou P, Chrousos GP, Michos A. Epidemiology and risk factors for coronary artery abnormalities in children with complete and incomplete Kawasaki disease during a 10-year period. Pediatr Cardiol 2013;34:1476-81. https://doi.org/10.1007/s00246-013-0673-9
  5. Nasser N, Bar-Oz B, Nir A. Natriuretic peptides and heart disease in infants and children. J Pediatr 2005;147:248-53. https://doi.org/10.1016/j.jpeds.2005.03.051
  6. Nir A, Nasser N. Clinical value of NT-ProBNP and BNP in pediatric cardiology. J Card Fail 2005;11(5 Suppl):S76-80. https://doi.org/10.1016/j.cardfail.2005.04.009
  7. Lee H, Kim H, Kim HS, Sohn S. NT-pro BNP: a new diagnostic screening tool for Kawasaki disease. Korean J Pediatr 2006;49: 539-44. https://doi.org/10.3345/kjp.2006.49.5.539
  8. Dahdah N, Siles A, Fournier A, Cousineau J, Delvin E, Saint-Cyr C, et al. Natriuretic peptide as an adjunctive diagnostic test in the acute phase of Kawasaki disease. Pediatr Cardiol 2009;30:810-7. https://doi.org/10.1007/s00246-009-9441-2
  9. Sato YZ, Molkara DP, Daniels LB, Tremoulet AH, Shimizu C, Kanegaye JT, et al. Cardiovascular biomarkers in acute Kawasaki disease. Int J Cardiol 2013;164:58-63. https://doi.org/10.1016/j.ijcard.2011.06.065
  10. Shiraishi M, Fuse S, Mori T, Doyama A, Honjyo S, Hoshino Y, et al. N-terminal pro-brain natriuretic Peptide as a useful diagnostic marker of acute Kawasaki disease in children. Circ J 2013;77: 2097-101. https://doi.org/10.1253/circj.CJ-12-1281
  11. Kaneko K, Yoshimura K, Ohashi A, Kimata T, Shimo T, Tsuji S. Prediction of the risk of coronary arterial lesions in Kawasaki disease by brain natriuretic peptide. Pediatr Cardiol 2011;32:1106-9. https://doi.org/10.1007/s00246-011-9986-8
  12. Yoshimura K, Kimata T, Mine K, Uchiyama T, Tsuji S, Kaneko K. N-terminal pro-brain natriuretic peptide and risk of coronary artery lesions and resistance to intravenous immunoglobulin in Kawasaki disease. J Pediatr 2013;162:1205-9. https://doi.org/10.1016/j.jpeds.2012.11.026
  13. Kim SY, Han MY, Cha SH, Jeon YB. 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. Pediatr Cardiol 2013;34:1837-43. https://doi.org/10.1007/s00246-013-0724-2
  14. Rusconi PG, Ludwig DA, Ratnasamy C, Mas R, Harmon WG, Colan SD, et al. Serial measurements of serum NT-proBNP as markers of left ventricular systolic function and remodeling in children with heart failure. Am Heart J 2010;160:776-83. https://doi.org/10.1016/j.ahj.2010.07.012
  15. Bang S, Yu JJ, Han MK, Ko HK, Chun S, Choi HS, et al. Logtransformed plasma level of brain natriuretic peptide during the acute phase of Kawasaki disease is quantitatively associated with myocardial dysfunction. Korean J Pediatr 2011;54:340-4. https://doi.org/10.3345/kjp.2011.54.8.340
  16. Ma KK, Ogawa T, de Bold AJ. Selective upregulation of cardiac brain natriuretic peptide at the transcriptional and translational levels by pro-inflammatory cytokines and by conditioned medium derived from mixed lymphocyte reactions via p38 MAP kinase. J Mol Cell Cardiol 2004;36:505-13. https://doi.org/10.1016/j.yjmcc.2004.01.001
  17. Baek JY, Song MS. Meta-analysis of factors predicting resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease. Korean J Pediatr 2016;59:80-90. https://doi.org/10.3345/kjp.2016.59.2.80
  18. Ha KS, Lee J, Jang GY, Lee J, Lee KC, Son CS, et al. Value of neutrophil-lymphocyte ratio in predicting outcomes in Kawasaki disease. Am J Cardiol 2015;116:301-6. https://doi.org/10.1016/j.amjcard.2015.04.021

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