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Diagnostic Yield of Cardiac Biomarker Testing in Predicting Cardiac Disease and Multisystem Inflammatory Syndrome in
Michael S Kelly, Neil D Fernandes1, Audrey V Carr
1Division of Pediatric Critical Care, Department of Pediatrics, Marshfield Children's Hospital, Marshfield, WI.
Insights
Elevated cardiac biomarkers in children during the COVID-19 era increase the likelihood of cardiac diagnoses or multisystem inflammatory syndrome in children (MIS-C). Further investigation is needed to reliably exclude cardiac disease, even with negative troponin levels.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Biomarker Research
Background:
- The COVID-19 pandemic and the emergence of multisystem inflammatory syndrome in children (MIS-C) have raised concerns about pediatric cardiac health.
- Assessing cardiac biomarkers in this context is crucial for timely diagnosis and management.
Purpose of the Study:
- To determine if elevated cardiac biomarkers are associated with cardiac diagnoses or MIS-C in pediatric patients.
- To evaluate the diagnostic performance of specific biomarkers like troponin T.
Main Methods:
- A retrospective analysis of 486 children who underwent troponin testing between April and December 2020.
- Statistical analysis to identify relationships between demographics, symptoms, cardiac diagnostics, and biomarker levels.
Main Results:
- A cardiac diagnosis or MIS-C was identified in 8.5% of patients.
- Elevated high-sensitivity troponin T (hsTropT) and N-terminal pro B-type natriuretic peptide were significantly associated with increased odds of cardiac diagnosis or MIS-C.
- hsTropT had a sensitivity of 54% and specificity of 89% for predicting these outcomes.
Conclusions:
- Elevated cardiac biomarkers in children warrant thorough workup for cardiac conditions or MIS-C, irrespective of the initial testing indication.
- While a negative hsTropT result can be reassuring, further research is necessary to develop reliable algorithms for excluding cardiac disease.
Objectives:
This study aimed to assess whether elevations in cardiac biomarkers are associated with pediatric cardiac diagnoses in the era of COVID-19 and multisystem inflammatory syndrome in children (MIS-C).
Study Design:
This single-center retrospective study analyzed children with a troponin drawn in the emergency department or inpatient unit between April 21 and December 31, 2020. The primary outcome was the presence of a cardiac diagnosis or MIS-C. Relationships among demographics, complaint, cardiac diagnostics, and cardiac biomarkers were analyzed.
Results:
Four hundred eighty-six patients (mean ± SD; age 13.1 ± 7.8 years; 46.7% women) met inclusion criteria, for whom a cardiac diagnosis (excluding MIS-C) was made in 27 (5.6%) patients, with MIS-C diagnosed in 14 (2.9%) patients. The sensitivity and specificity of an elevated initial high-sensitivity troponin T (hsTropT) value (>14 ng/L) in predicting the composite outcome of a cardiac diagnosis or MIS-C were 54% and 89%, respectively. Four percent of patients with negative initial troponin values were found to have a cardiac diagnosis or MIS-C. Multivariable regression analysis demonstrated that elevated hsTropT (>14 ng/L; odds ratio [OR] [95% confidence interval]: 4.9 [1.70-14.0]) and elevated N-terminal pro B-type natriuretic peptide values (>500 pg/mL; 6.4 [2.01-20.1]) were associated with increased odds of a cardiac diagnosis or MIS-C.
Conclusions:
Children with elevated cardiac biomarkers have increased odds of a cardiac diagnosis or MIS-C and warrant workup regardless of indication for testing. Although a negative hsTropT may reassure providers, further investigation is critical in developing algorithms to reliably exclude cardiac disease.
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