| Objective To observe the changes of N-terminal pro-brain natriuretic peptide(NT-proBNP)in diagnosis of Kawasaki disease(K D)and different responses to high-dose intravenous immunoglobulin(IVIG),and to further explore the value of different age groups of NT-proBNP in KD diagnosis and prediction of IVIG non-response,and to explore the significance of different NT-proBNP cut off values in KD diagnosis and early prediction of IVIG non-responsive KD.Methods The 299 children with KD who were treated in our hospital from January 2010 to December 2020,including complete KD(c KD)(n=224)and incomplete KD(i KD)(n=75),were divide d into IVIG non-responsive group(n=41)and IVIG responsive group(n=258)according to the response to IVIG treatment,and further divided into 2 subgroups:3-12 months old group,>12 months old group.NT-proBNP and echocardiography were performed on admis sion,and 107 febrile children(including 45 cases of acute pulmonary infection,35 cases of acute suppu rative tonsillitis and 27cases of acute lymphadenitis)in the same period were taken as the control group.The changes of NT-proBNP among different gro ups and in different age groups were compared,and the cutoff values of NT-proBNP diagnosis and predicti on of IVIG non-responsive KD were obtained by using ROC curve.Result The NT-proBNP of KD group(median 529.2pg/ml,IQR:259.9,1051)was compared with the control group(median 100.0pg/ml,IQR:50.0,220.0)(Z=-11.383,P<0.0001),there was a statistical difference between the two groups.However there was no significant difference between c KD group(median 549.9pg,IQR:227.2,1057.8)and i KD group(median 452.0pg/ml,IQR:197,1051.0)in NT-proBNP(Z=-0.901,P>0.05).According to the ROC curve,the best cut-off value of NT-proBNP for diagnosing KD was320.1pg/ml,the sensitivity and the specificity were 69.2%and 91.5%,and the AUC was 0.869,95%CI:0.83-0.90.After segmentation according to age,the best critical value of 3-12 months old group NT-proBNP for diagnosing KD was 356.4pg/ml,with a sensitivity of 71.71%and a specificity of 97.06%.The best cutoff value for diagnosing KD in the>12 months old gr oup was209.3pg/ml,the sensitivity was 74.83%,specificity was 88.57%.The diagnostic value of NT-proBNP 450pg/ml,which was in the diagnosis of heart failure and 320.1pg/ml,356.4pg/ml and 209.3pg/ml was compared with that of KD.When the diagnostic cutof f value of NT-proBNP was set to450pg/ml,the sensitivity and specificity were 0.55 and 0.98.When the diagnostic cutoff values were 320.1pg/ml,356.4pg/ml and 209.3pg/ml,the corresponding sensitivity,specificity and Youden index were 0.69,0.92,0.61;0.65,0.94,0.59;0.80,0.74,0.54.At the same time,it was found that the positive rate of NT-proBNP in the early stage of KD was much higher than that of CAL detected by echocardiography,there was statistically significant between two groups(c~2=69.03,P<0.005).The children with IVIG non-responsive KD tended to increase year by year.The NT-proBNP of IVIG non-responsive group was much higher than of IVIG responsive group(2988.0pg/ml vs 438.7pg/ml).The difference was statistically significant(Z=-0.848,P<0.001).According to ROC curve analysis,the best critical value of NT-proBNP for predicting IVIG non-responsive KD was 1550pg/ml,with sensitivity 94.19%,specificity 90.24%.AUC:0.912,95%CI:0.83-0.98.According to the patient’s age,we divided the IVIG no n-responsive patients into two groups,they were 3-12 months old group and>12 months old group.There was no age difference in NT-proBNP level of KD children between the two groups(Z=-0.041,P>0.05).Conclusion1.NT-proBNP could be used as a laboratory index for differential diagnosis between KD and other febrile diseases.2.NT-proBNP had a certain diagnostic value for KD.The best cut-off value for the diagnosis of KD was 320.1pg Uniml,the sensitivity was 69.2%,and the specificity was 91.6%.3.The best cut-off value of NT-proBNP obtained by age stratification had higher diagnostic value in the diagnosis o f KD in this age group.The best cut-off values of NT-proBNP in different age stratification were356.4pg/ml(3-12 months old)and 209.3pg/ml(>12 months old).4.The diagnosis of heart failure with NT-proBNP cut-off value450pg/ml diagnosis of KD would cause more missed diagnosis of KD children,so using NT-proBNP cutoff value 320.1pg/ml to diagnose KD was better than 450pg/ml.5.The value of NT-proBNP in the early diagnosis of KD was better than that of echocardiography.6.NT-proBNP had good application value in predicting whether there was a response to IVIG or not.The best cutoff value for predicting IVIG non-response was 1550pg/ml,the sensitivity was 94.19%,and the specificity was 90.24%. |
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