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Differentiation of COVID-19-Associated Multisystem Inflammatory Syndrome From Kawasaki Disease With the Use of
Michael D Fridman1, Paul Tsoukas2, Aamir Jeewa1
1Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Cardiac biomarkers like troponin I and NT-proBNP can help distinguish Multisystem Inflammatory Syndrome in Children (MIS-C) from Kawasaki disease (KD). Elevated levels may indicate MIS-C, aiding diagnosis when COVID-19 history is unclear.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Multisystem Inflammatory Syndrome in Children (MIS-C) shares clinical similarities with Kawasaki Disease (KD).
- Differentiating MIS-C from KD is crucial for appropriate management.
- The role of cardiac biomarkers in distinguishing these conditions requires further investigation.
Purpose of the Study:
- To determine if cardiac biomarker levels can differentiate MIS-C from KD.
- To assess the association between cardiac biomarker levels and cardiac involvement in MIS-C and KD.
Main Methods:
- Retrospective analysis of 38 MIS-C patients (post-COVID-19) and 70 KD patients (prepandemic and contemporaneous).
- Comparison of clinical, echocardiographic, electrocardiographic, and laboratory data within 72 hours of biomarker assessment.
- Multivariable regression and ROC curve analyses to evaluate biomarker associations with diagnosis and cardiac involvement.
Main Results:
- MIS-C patients exhibited more shock, ICU admission, and ventricular dysfunction, but similar coronary artery involvement compared to KD.
- Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (TnI) were associated with MIS-C.
- High sensitivity and specificity were observed for TnI (>10 ng/L) and NT-proBNP (>2000 ng/L) in predicting MIS-C versus KD.
Conclusions:
- Positive TnI and elevated NT-proBNP levels may help differentiate MIS-C from KD.
- These biomarkers may become increasingly important for diagnosis as COVID-19 evidence becomes less clear.
- Cardiac biomarkers showed limited association with cardiac involvement in this study population.
Background:
Multisystem inflammatory syndrome in children (MIS-C) after COVID-19 shares clinical similarities to Kawasaki disease (KD). We sought to determine whether cardiac biomarker levels differentiate MIS-C from KD and their association with cardiac involvement.
Methods:
Subjects included 38 MIS-C patients with confirmed prior COVID-19 and 32 prepandemic and 38 contemporaneous KD patients with no evidence of COVID-19. Patient, clinical, echocardiographic, electrocardiographic, and laboratory data timed within 72 hours of cardiac biomarker assessment were abstracted. Groups were compared, and regression analyses were used to determine associations between biomarker levels, diagnosis and cardiac involvement, adjusting for clinical factors.
Results:
MIS-C patients had fewer KD clinical features, with more frequent shock, intensive care unit admission, inotrope requirement, and ventricular dysfunction, with no difference regarding coronary artery involvement. Multivariable regression analysis showed that both higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (TnI) were associated with MIS-C vs KD, after adjusting for significant covariates. Receiver operating characteristic curves for diagnosis showed that any detectable TnI greater than 10 ng/L was predictive of MIS-C vs KD with 91% sensitivity and 76% specificity. NT-proBNP > 2000 ng/L predicted MIS-C vs KD with 82% sensitivity and 82% specificity. Higher TnI but not NT-proBNP was associated with lower LV ejection fraction. Neither biomarker was associated with coronary artery involvement.
Conclusions:
Positive TnI and higher NT-proBNP may differentiate MIS-C from KD, which may become more relevant as evidence of prior COVID-19 becomes more challenging to determine. Cardiac biomarkers may have limited associations with cardiac involvement in this setting.
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