B-type natriuretic peptide and N-terminal pro-BNP in the acute phase of Kawasaki disease

Satoru Iwashima, Takamichi Ishikawa

Hamamatsu, Japan

Author Affiliations: Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan (Iwashima S, Ishikawa T)

Corresponding Author: Satoru Iwashima, MD, Department of Pediatrics, Hamamatsu University School of Medicine, Handayama 1-20-1, Hamamatsu City 431-3192, Japan (Tel: +81-53-435-2312; Fax: +81-53-435-2311; Email: iwashima@hama-med.ac.jp)

doi: 10.1007/s12519-013-0402-8

Background: This study was undertaken to identify factors correlating with plasma levels of B-type natriuretic peptide (BNP) and its N-terminal portion (NT-pro BNP) in the acute phase of Kawasaki disease (KD).

Methods: This study included 91 patients with KD treated at a hospital affiliated to Hamamatsu University School of Medicine between October 2003 and June 2011. We quantified BNP and NT-pro BNP in the acute phase. The BNP level was expressed as the NT-pro BNP level using the formula NT-pro BNP=9.080×BNP^0.923. We sought relationships between NT-pro BNP values and different clinical and laboratory data in the acute phase of KD.

Results: Of the 91 patients, 14 failed to respond to the initial intravenous immunoglobulins therapy. NT-pro BNP levels were significantly higher in these non-responders than in the responders (1689.3±1168.8 pg/dL vs. 844.4±1276.3 pg/dL, P<0.001). Seventeen patients developed coronary artery lesions, but this was not associated with NT-proBNP levels. NT-pro BNP was positively correlated with CRP (r=0.421, P<0.001) and negatively correlated with the hematocrit (r=-0.206, P=0.050), Na value (r=-0.214, P=0.041) and albumin level (r=-0.345, P<0.001). Stepwise multiple linear regression analysis with NT-pro BNP as a dependent variable revealed significant correlations with CRP and albumin (beta=0.345, P=0.001; beta=-0.225, P=0.027).

Conclusions: A high level of NT-pro BNP in acute phase KD is associated with systemic inflammatory responses and increased vascular permeability. The NT-pro BNP level is a useful marker to identify potential non-responders to IVIG among KD patients.

Key words: B-type natriuretic peptide; Kawasaki disease; myocarditis; NT pro BNP

World J Pediatr 2013;9(3):239-244