NYMC Faculty Publications

Cardiac Biomarkers Aid in Differentiation of Kawasaki Disease From Multisystem Inflammatory Syndrome in Children Associated With COVID-19

Mollie Walton, Children's Mercy Hospitals and Clinics
Geetha Raghuveer, Children's Mercy Hospitals and Clinics
Ashraf Harahsheh, The George Washington University School of Medicine and Health Sciences
Michael A. Portman, Seattle Children’s Research Institute
Simon Lee, Nationwide Children’s Hospital
Michael Khoury, University of Alberta, Faculty of Medicine and Dentistry
Nagib Dahdah, University of Montreal
Marianna Fabi, IRCCS Azienda Ospedaliero-Universitaria di Bologna
Audrey Dionne, Harvard Medical School
Tyler H. Harris, UPMC Children’s Hospital of Pittsburgh
Nadine Choueiter, The Children’s Hospital at Montefiore
Luis Martin Garrido-Garcia, Hospital Angeles de las Lomas
Supriya Jain, Westchester Medical Center
Frédéric Dallaire, Université de Sherbrooke
Nilanjana Misra, Cohen Children’s Medical Center
Mark D. Hicar, Jacobs School of Medicine and Biomedical Sciences
Therese M. Giglia, The Children's Hospital of Philadelphia
Dongngan T. Truong, The University of Utah
Elif Seda Selamet Tierney, Lucile Packard Children's Hospital Stanford
Deepika Thacker, Nemours Children's Health System
Todd T. Nowlen, Phoenix Children's Hospital
Jacqueline R. Szmuszkovicz, Children's Hospital Los Angeles
Kambiz Norozi, Western University
William B. Orr, Washington University School of Medicine in St. Louis
Pedrom Farid, The Hospital for Sick Children
Cedric Manlhiot, Johns Hopkins University
Brian W. McCrindle, The Hospital for Sick Children
Sindhu Mohandas
Varsha Zadokar
Anji T. Yetman
Marco Antonio Yamazaki-Naksahimada
Laurence Watelle

Author Type(s)

Faculty

DOI

10.1007/s00246-023-03338-z

Journal Title

Pediatric Cardiology

First Page

116

Last Page

126

Document Type

Article

Publication Date

1-1-2025

Department

Pediatrics

Keywords

Amino-terminal prohormone brain natriuretic peptide (NTproBNP), Cardiac biomarkers, Kawasaki disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C), Troponin I (TnI)

Disciplines

Medicine and Health Sciences

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.

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