Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

An Erratum to this article was published on 28 November 2013

Abstract

Intravenous immunoglobulin (IVIG) administered in the acute stage of Kawasaki disease (KD) is the standard therapy. Few reports describe nonresponders to initial treatment with IVIG in KD, which remains the most consistent risk factor for coronary artery lesions (CALs). This study aimed to investigate whether the serum level of N-terminal pro-brain natriuretic peptide (NT-proBNP) can be a predictive indicator for identifying patients with KD at higher risk of IVIG treatment failure. In this study, 135 patients with a diagnosis of KD admitted for IVIG treatment were retrospectively enrolled for analysis. Of these 135 patients, 22 were nonresponders who received additional rescue therapy because they had an elevated body temperature 36 h after completion of initial IVIG treatment. The NT-proBNP concentration was significantly higher in the nonresponder group (2,465.36 ± 3,293.24 pg/mL) than in the responder group (942.38 ± 1,293.48 pg/mL) (p < 0.05). The optimal sensitivity and specificity cutoff point for predicted nonresponders was 1,093.00 pg/mL or higher. The sensitivity and specificity for prediction of IVIG response were respectively 70.0 and 76.5 %. The findings show that NT-proBNP is a helpful marker in determining patients at risk for not responding to initial IVIG treatment. The authors suggest that patients with an NT-proBNP level of 1,093.00 pg/dL or higher are likely to fail initial IVIG and may require further rescue therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ayusawa M, Sonobe T, Uemura S, Ogawa S, Nakamura Y, Kiyosawa N, Kawasaki Disease Research Committee et al (2005) Revision of diagnostic guidelines for Kawasaki disease. 5th rev ed. Pediatr Int 47:232–234

    Article  PubMed  Google Scholar 

  2. Beiser AS, Takahashi M, Baker AL, Sundel RP, Newburger JW (1998) A predictive instrument for coronary artery aneurysms in Kawasaki disease. US Multicenter Kawasaki Disease Study Group. Am J Cardiol 81:1116–1120

    Article  CAS  PubMed  Google Scholar 

  3. Burns JC, Best BM, Mejias A, Mahony L, Fixler DE, Jafri HS et al (2008) Infliximab treatment of intravenous immunoglobulin-resistant Kawasaki disease. J Pediatr 153:833–838

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Cowie MR, Mendez GF (2002) BNP and congestive heart failure. Prog Cardiovasc Dis 44:293–321

    Article  CAS  PubMed  Google Scholar 

  5. Dahdah N, Siles A, Fournier A, Cousineau J, Delvin E, Saint-Cyr C et al (2009) Natriuretic peptide as an adjunctive diagnostic test in the acute phase of Kawasaki disease. Pediatr Cardiol 30:810–817

    Article  PubMed  Google Scholar 

  6. Dong won L, Yeo Hyang K, Myung Chul H, Tae Chan K, Sang Bum L (2010) NT-proBNP as a useful tool in diagnosing incomplete Kawasaki disease. Korean J Pediatr 53:519–524

    Article  Google Scholar 

  7. Durongpisitkul K, Soongswang J, Laohaprasitiporn D, Nana A, Prachuabmoh C, Kangkagate C (2003) Immunoglobulin failure and retreatment in Kawasaki disease. Pediatr Cardiol 24:145–148

    Article  CAS  PubMed  Google Scholar 

  8. Egami K, Muta H, Ishii M, Suda K, Sugahara Y, Iemura M et al (2006) Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease. J Pediatr 149:237–240

    Article  CAS  PubMed  Google Scholar 

  9. Fukunishi M, Kikkawa M, Hamana K, Onodera T, Matsuzaki K, Matsumoto Y et al (2000) Prediction of nonresponse to intravenous high-dose gammaglobulin therapy in patients with Kawasaki disease at onset. J Pediatr 137:172–176

    Article  CAS  PubMed  Google Scholar 

  10. Iwasa M, Sugiyama K, Ando T, Nomura H, Katoh T, Wada Y (1987) Selection of high-risk children for immunoglobulin therapy in Kawasaki disease. Prog Clin Biol Res 250:543–544

    CAS  PubMed  Google Scholar 

  11. Iwashima S, Kimura M, Ishikawa T, Ohzeki T (2011) Importance of C-reactive protein level in predicting nonresponse to additional intravenous immunoglobulin treatment in children with Kawasaki disease. Clin Drug Investig 31:191–199

    Article  CAS  PubMed  Google Scholar 

  12. Kaneko K, Yoshimura K, Ohashi A, Kimata T, Shimo T, Tsuji S (2011) Prediction of the risk of coronary arterial lesions in Kawasaki disease by brain natriuretic peptide. Pediatr Cardiol 32:1106–1109

    Article  PubMed  Google Scholar 

  13. Kawamura T, Wago M (2002) Brain natriuretic peptide can be a useful biochemical marker for myocarditis in patients with Kawasaki disease. Cardiol Young 12:153–158

    Article  PubMed  Google Scholar 

  14. Kawamura T, Wago M, Kawaguchi H, Tahara M, Yuge M (2000) Plasma brain natriuretic peptide concentrations in patients with Kawasaki disease. Pediatr Int 42:241–248

    Article  CAS  PubMed  Google Scholar 

  15. Kobayashi T, Inoue Y, Takeuchi K, Okada Y, Tamura K, Tomomasa T et al (2006) Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 113:2606–2612

    Article  PubMed  Google Scholar 

  16. Kobayashi T, Inoue Y, Otani T, Morikawa A, Kobayashi T, Takeuchi K et al (2009) Risk stratification in the decision to include prednisolone with intravenous immunoglobulin in primary therapy of Kawasaki disease. Pediatr Infect Dis J 28:498–502

    Article  PubMed  Google Scholar 

  17. Kuo HC, Liang CD, Wang CL, Yu HR, Hwang KP, Yang KD (2010) Serum albumin level predicts initial intravenous immunoglobulin treatment failure in Kawasaki disease. Acta Paediatr 99:1578–1583

    Article  PubMed  Google Scholar 

  18. Kurotobi S, Kawakami N, Shimizu K, Aoki H, Nasuno S, Takahashi K et al (2005) Brain natriuretic peptide as a hormonal marker of ventricular diastolic dysfunction in children with Kawasaki disease. Pediatr Cardiol 26:425–430

    Article  CAS  PubMed  Google Scholar 

  19. Lee H, Kim H, Kim HS, Sohn S (2006) NT-proBNP: a new diagnostic screening tool for Kawasaki disease. Korean J Pediatr 49:539–544

    Article  Google Scholar 

  20. Muta H, Ishii M, Furui J, Nakamura Y, Matsuishi T (2006) Risk factors associated with the need for additional intravenous gamma-globulin therapy for Kawasaki disease. Acta Paediatr 95:189–193

    Article  PubMed  Google Scholar 

  21. Muta H, Ishii M, Furui J, Nakamura Y, Matsuishi T (2006) Risk factors associated with the need for additional intravenous gamma-globulin therapy for Kawasaki disease. Acta Paediatr 95:189–193

    Article  PubMed  Google Scholar 

  22. Nakamura Y, Yashiro M, Uehara R, Watanabe M, Tajimi M, Oki I et al (2004) Use of laboratory data to identify risk factors of giant coronary aneurysms due to Kawasaki disease. Pediatr Int 46:33–38

    Article  PubMed  Google Scholar 

  23. Nakano H, Ueda K, Saito A, Tsuchitani Y, Kawamori J, Miyake T (1986) Scoring method for identifying patients with Kawasaki disease at high risk of coronary artery aneurysms. Am J Cardiol 58:739–742

    Article  CAS  PubMed  Google Scholar 

  24. Newburger JW, Takahashi M, Beiser AS, Burns JC, Bastian J, Chung KJ et al (1991) A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Engl J Med 324:1633–1639

    Article  CAS  PubMed  Google Scholar 

  25. Ogata S, Ogihara Y, Honda T, Kon S, Akiyama K, Ishii M (2012) Corticosteroid pulse combination therapy for refractory Kawasaki disease: a randomized trial. Pediatrics 129:e17–e23

    Article  PubMed  Google Scholar 

  26. Park MJ, Jeon I-S, Tchah H, Cho KH, Jung M-J, Choi DY (2009) Predictive indicators of coronary artery complications in Kawasaki disease. Korean J Pediatr 52:1161–1166

    Article  Google Scholar 

  27. Park YW, Han JW, Hong YM, Ma JS, Cha SH, Kwon TC et al (2011) Epidemiological features of Kawasaki disease in Korea, 2006–2008. Pediatr Int 53:36–39

    Article  PubMed  Google Scholar 

  28. Pfister R, Scholz M, Wielckens K, Erdmann E, Schneider CA (2004) Use of NT-proBNP in routine testing and comparison to BNP. Eur J Heart Fail 6:289–293

    Article  CAS  PubMed  Google Scholar 

  29. Sano T, Kurotobi S, Matsuzaki K, Yamamoto T, Maki I, Miki K et al (2007) Prediction of nonresponsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment. Eur J Pediatr 166:131–137

    Article  CAS  PubMed  Google Scholar 

  30. Tang WH (2007) B-type natriuretic peptide: a critical review. Congest Heart Fail 13:48–52

    Article  CAS  PubMed  Google Scholar 

  31. Taubert K (1997) Epidemiology of Kawasaki disease in the United States and worldwide. Prog Pediatr Cardiol 6:181–185

    Article  Google Scholar 

  32. Tremoulet AH, Best BM, Song S, Wang S, Corinaldesi E, Eichenfield JR et al (2008) Resistance to intravenous immunoglobulin in children with Kawasaki disease. J Pediatr 153:117–121

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Uehara R, Belay ED, Maddox RA, Holman RC, Nakamura Y, Yashiro M et al (2008) Analysis of potential risk factors associated with nonresponse to initial intravenous immunoglobulin treatment among Kawasaki disease patients in Japan. Pediatr Infect Dis J 27:155–160

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Kyunghee University School of Medicine, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea

    So Youn Kim, Mi Young Han & Sung-Ho Cha

  2. Department of Cardiothoracic Surgery, Gachon University School of Medicine, Incheon, South Korea

    Yang Bin Jeon

Authors
  1. So Youn Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mi Young Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sung-Ho Cha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yang Bin Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mi Young Han.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kim, S.Y., Han, M.Y., Cha, SH. et al. 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 34, 1837–1843 (2013). https://doi.org/10.1007/s00246-013-0724-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-013-0724-2

Keywords

Search

Navigation