Abstract O.34: NT-proBNP based Algorithm for Diagnosis and Treatment of Kawasaki Disease - Are we there yet?
Background: Diagnosis of Kawasaki Disease (KD) can be confusing in the absence of a confirmatory test or pathognomonic finding, especially when clinical criteria are incomplete (iKD). We have lately proposed serum NT-proBNP as an adjunctive diagnostic test.
Method: We retrospectively tested a new diagnostic algorithm to aid in diagnosis based on NT-proBNP (Z-score for age), coronary artery dilation (CAD) at onset, and abnormal serum albumin or CRP. The goal was to assess the performance of the algorithm with respect to CAD outcome (aneurysm, dilation, or occult dilation). Occult dilation is defined as variation of coronary artery Z-score >2 within the normal range (<2.5).
Results: The algorithm was tested on 81 KD patients who had NT-proBNP on admission at our institution between 2008 and 2013. Age at diagnosis was 3.2 ± 2.6 years, with a median of 5 diagnostic criteria (range 3-6), of whom 31/81 (38.3%) had iKD. Aneurysms occurred in 16/81 (19.8%); higher prevalence in iKD, 12/31 (38.7%) versus 4/50 (8.0%) (p=0.001). CAD affected 35/81 (43.2%), and 30/81 (37.0%) had occult CAD. With the algorithm, 80/81 (98.8%) were to be treated: based on high NT-proBNP alone for 54/81 (66.7%), on onset CAD for 13/81 (16.0%), and on high CRP or low albumin for 13/81 (16.0%). (Figure 1) Results were similar when the algorithm was applied to patients with complete or incomplete criteria. The only patient “not-to-treat” with the algorithm had iKD and transient occult CAD.
Conclusion: This NT-proBNP based algorithm is efficient to identify and treat patients at risk of coronary involvement, despite an apparent selection bias of CA involvement. This paves the way for a prospective validation trial of the algorithm.
Author Disclosures: A. Dionne: None. L. Meloche-dumas: None. A. Fournier: None. N. Dahdah: None.
- © 2015 by American Heart Association, Inc.