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NT-pro BNP : A new diagnostic screening tool for Kawasaki disease

Korean Journal of Pediatrics 2006;49(5):539-544.
Published online May 15, 2006.
NT-pro BNP : A new diagnostic screening tool for Kawasaki disease
Hyunju Lee, Heejung Kim, Hae Soon Kim, Sejung Sohn
Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
가와사끼병에서 진단적 지표로서의 NT-proBNP
이현주, 김희정, 김혜순, 손세정
이화여자대학교 의과대학 소아과학교실
Correspondence: 
Sejung Sohn, Email: sohn@ewha.ac.kr
Abstract
Purpose
: The purpose of this study was to determine whether N-terminal fragment of B-type natriuretic peptide(NT-proBNP) may be used to differentiate acute Kawasaki disease(KD) from other clinically similar diseases.
Methods
: Using electrochemiluminescence immunoassay, NT-proBNP concentrations were measured in the acute phase within 10 days after the onset of KD(n=58) and in the convalescent phase, 60 to 81 days after the onset(n=51), and also in patients with acute febrile disease as a control(n=34). Echocardiography was performed to detect pericardial effusion(PE) and coronary artery lesions(CAL), and to measure the left ventricular dimension at diastole(LVIDd) and ejection fraction(LVEF). The cutoff value of NT-proBNP for separating KD from other diseases was determined.
Results
: NT-proBNP concentration in the acute phases of KD was significantly higher than that in the control group(1,501.6¡¾2,132.6 vs. 139.0¡¾88.8 pg/mL, P<0.0001). In KD patients, NT-proBNP was elevated in the acute phase and was lowered in the convalescent phase(1,466.0¡¾2,173.2 vs. 117.5¡¾95.5 pg/mL, P<0.0001). The cutoff value of 260 pg/mL discriminated KD patients from other patients, with a sensitivity of 93 percent and a specificity of 88 percent. The NT-proBNP was higher in patients with PE(n=17) compared with those without PE(n=41)(1,784.2¡¾1,903.1 vs. 1,384.4¡¾2,232.6 pg/mL, P=0.52). Comparison of NT-proBNP could not be done between patients with CAL and those without, owing to a small number of patients with CAL(n=3). There was no correlation between NT-proBNP and LVEF index(r=0.104, P=0.46) or LVIDd index(r=0.171, P=0.22).
Conclusion
: NT-proBNP increases in the acute phase of KD and decreases to within normal range in the convalescent phase. NT-proBNP >260 pg/mL may be highly suggestive of acute KD. NT- proBNP may be used as a diagnostic tool for KD.
Key Words: NT-proBNP , Kawasaki disease


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