Journal article
Cardiac Biomarkers Aid in Differentiation of Kawasaki Disease from Multisystem Inflammatory Syndrome in Children Associated with COVID-19
Pediatric cardiology, Vol.46(1), pp.116-126
01/01/2025
DOI: 10.1007/s00246-023-03338-z
PMCID: PMC11213824
PMID: 38157048
Abstract
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.
Details
- Title: Subtitle
- Cardiac Biomarkers Aid in Differentiation of Kawasaki Disease from Multisystem Inflammatory Syndrome in Children Associated with COVID-19
- Creators
- Mollie Walton - Mercy HospitalGeetha Raghuveer - Children's Mercy HospitalAshraf Harahsheh - George Washington UniversityMichael A. Portman - Seattle Children's Research InstituteSimon Lee - Nationwide Children's HospitalMichael Khoury - University of AlbertaNagib Dahdah - Université de MontréalMarianna Fabi - Azienda USL di BolognaAudrey Dionne - Boston Children's HospitalTyler H. Harris - Children's Hospital of PittsburghNadine Choueiter - Children's Hospital at MontefioreLuis Martin Garrido-Garcia - Instituto Nacional de PediatriaSupriya Jain - Maria Fareri Children's HospitalFrédéric Dallaire - Université de SherbrookeNilanjana Misra - Cohen Children's Medical CenterMark D. Hicar - Jacobs (Spain)Therese M. Giglia - Children's Hospital of PhiladelphiaDongngan T. Truong - Primary Children's HospitalElif Seda Selamet Tierney - Lucile Packard Children's HospitalDeepika Thacker - Nemours Children’s HospitalTodd T. Nowlen - Phoenix Children's HospitalJacqueline R. Szmuszkovicz - Children's Hospital of Los AngelesKambiz Norozi - Western UniversityWilliam B. Orr - Washington University in St. LouisPedrom Farid - Hospital for Sick ChildrenCedric Manlhiot - Johns Hopkins UniversityBrian W. McCrindle - University of TorontoInternational Kawasaki Disease RegistryHidemi Kajimoto (Contributor) - Stead Family Department of Pediatrics
- Resource Type
- Journal article
- Publication Details
- Pediatric cardiology, Vol.46(1), pp.116-126
- DOI
- 10.1007/s00246-023-03338-z
- PMID
- 38157048
- PMCID
- PMC11213824
- NLM abbreviation
- Pediatr Cardiol
- ISSN
- 0172-0643
- eISSN
- 1432-1971
- Publisher
- Springer US
- Number of pages
- 11
- Grant note
- BoBeau Coeur McCance Family Fund R01 HL143130; NIH OTA-21-015E; R61HD105591 / National Institutes of Health (http://dx.doi.org/10.13039/100000002)
- Language
- English
- Date published
- 01/01/2025
- Academic Unit
- Cardiology; Stead Family Department of Pediatrics
- Record Identifier
- 9984961027302771
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