Cardiac Biomarkers Aid in Differentiation of Kawasaki Disease from Multisystem Inflammatory Syndrome in Children Associated with COVID-19

Mollie Walton, Children's Mercy Hospital, Kansas City, MO, USA. mmwalton@cmh.edu.
Geetha Raghuveer, Children's Mercy Hospital, Kansas City, MO, USA.
Ashraf Harahsheh, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Michael A. Portman, Seattle Children's Research Institute, Seattle, WA, USA.
Simon Lee, The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA.
Michael Khoury, Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Nagib Dahdah, Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, QC, Canada.
Marianna Fabi, Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
Audrey Dionne, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Tyler H. Harris, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Nadine Choueiter, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
Luis Martin Garrido-Garcia, Hospital Angeles Lomas, Huixquilucan, Mexico.
Supriya Jain, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA.
Frédéric Dallaire, Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada.
Nilanjana Misra, Cohen Children's Medical Center, Northwell Health, Queens, NY, USA.
Mark D. Hicar, Jacobs School of Medicine and BioMedical Sciences, University at Buffalo, Buffalo, NY, USA.
Therese M. Giglia, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Dongngan T. Truong, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA.
Elif Seda Tierney, Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA.
Deepika Thacker, Nemours Children's Hospital, Wilmington, DE, USA.
Todd T. Nowlen, Phoenix Children's Hospital, Phoenix, AZ, USA.
Jacqueline R. Szmuszkovicz, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
Kambiz Norozi, Department of Pediatrics, Pediatric Cardiology, Western University, London, ON, Canada.
William B. Orr, Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA.
Pedrom Farid, Department of Pediatrics, The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, ON, Canada.
Cedric Manlhiot, Blalock-Taussig-Thomas Congenital Heart Center, Johns Hopkins University, Baltimore, MD, USA.
Brian W. McCrindle, Department of Pediatrics, The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, ON, Canada.

Document Type

Journal Article

Publication Date

1-1-2025

Journal

Pediatric cardiology

Volume

46

Issue

1

DOI

10.1007/s00246-023-03338-z

Keywords

Amino-terminal prohormone brain natriuretic peptide (NTproBNP); Cardiac biomarkers; Kawasaki disease (KD); Multisystem Inflammatory Syndrome in Children (MIS-C); Troponin I (TnI)

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.

Department

Pediatrics

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