Related Experiment Video
Updated: Jul 6, 2025
Author Spotlight: Integrated Multi-Omics Analysis for Unveiling Multicellular Immune Signatures in Clinical Heart Attack Cohorts
Published on: September 20, 2024
Cardiac Biomarkers Aid in Differentiation of Kawasaki Disease from Multisystem Inflammatory Syndrome in Children
Mollie Walton1,2, Geetha Raghuveer3, Ashraf Harahsheh4
1Children's Mercy Hospital, Kansas City, MO, USA. mmwalton@cmh.edu.
Insights
Cardiac biomarkers like NTproBNP and troponin I can help differentiate Kawasaki disease (KD) from MIS-C in children. Higher levels suggest MIS-C, aiding clinical diagnosis when definitive tests are lacking.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Biomarker Research
Background:
- Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) share clinical features.
- Both conditions lack definitive diagnostic tests, complicating differentiation.
- Cardiac involvement is a concern in both KD and MIS-C.
Purpose of the Study:
- To investigate the utility of cardiac biomarkers in differentiating KD from MIS-C.
- To assess the association of NTproBNP and troponin I levels with diagnosis and cardiac involvement.
Main Methods:
- Retrospective cohort study using data from the International Kawasaki Disease Registry (January 2020 - June 2022).
- Included 118 KD patients and 946 MIS-C patients with available cardiac biomarker (NTproBNP, TnI) and echocardiography data.
- Regression analyses were performed to correlate biomarker levels with diagnosis, clinical outcomes, and cardiac function.
Main Results:
- Elevated NTproBNP (≥1500 ng/L) and TnI (≥20 ng/L) at presentation were significantly associated with MIS-C compared to KD (77% and 89% specificity, respectively).
- Higher biomarker levels correlated with shock, intensive care unit admission, and longer hospital stays (NTproBNP).
- Lower left ventricular ejection fraction was more pronounced in MIS-C and associated with higher biomarker levels; coronary artery involvement was not linked to these biomarkers.
Conclusions:
- Higher NTproBNP and TnI levels at presentation are indicative of MIS-C over KD.
- These cardiac biomarkers may be valuable tools for clinical differentiation between MIS-C and KD.
- Consideration should be given to incorporating NTproBNP and TnI into the routine evaluation of pediatric patients with suspected KD or MIS-C.
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.
More Related Videos
10:03Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
10:12A Sensitive and Specific Quantitation Method for Determination of Serum Cardiac Myosin Binding Protein-C by Electrochemiluminescence Immunoassay
Published on: August 8, 2013
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...