N-Terminal Pro-Brain Natriuretic Peptide As Predictor Factor To Coronary Artery Lesions In Kawasaki Disease
Najla Mustafa Asaiah
Department of Pediatric, Sabratha Higher Institute of Medical Technology, National Board Technical vocational, Libya
Azab Elsayed Azab
Physiology Department, Faculty of Medicine, Sabratha University, Libya
Abduraouf Alamer Mohamed
Faculty of Science, Zawia University, Libya
Keywords: Kawasaki disease, Incomplete Kawasaki disease, NT-proBNP, Coronary artery lesions, IVIG response, non-response
Abstract
Kawasaki disease (KD) is an acute systemic vasculitis of childhood associated with the development of coronary artery lesions in 15-25% of untreated children, and in 3-5% of children treated by intravenous immunoglobulin, may leads to ischemic heart disease or sudden death. KD makes a challenge for the clinicians because the diagnosis of KD based on clinical data, not pathognomic symptoms, and no laboratory tests are available to diagnose KD. Objectives: The present study aimed to investigate whether the serum level of N-terminal pro-brain natriuretic peptide (NT-proBNP) can be a predictive indicator not only to diagnose KD, but also used to identify patients who have a character of incomplete Kawasaki disease (IKD), have a high risk of coronary artery lesions (CAL), and whom resistance to intravenous immunoglobulin (IVIG). Methods: The clinical data of 155 KD cases from May 2013 to June 2014 admitted to pediatric cardiology at Tongji medical university hospital. The demographic clinical and laboratory data were collected. The differences in parameters were compared between three groups: A)IKD, typical Kawasaki disease (TKD), and control groups, B)CAL-KD, NCAL-KD, and control groups, C) IVIG sensitive KD, IVIG non-response KD, and control groups. The statistical significance of differences among several groups was analyzed by ANOVA. When variances in groups are equal, comparisons of two groups were analyzed by using LSD test. On the contrary, when variances in groups are not equal, comparisons of two groups were analyzed by using Tamhane’s T2 test, (P<0.05 was considered significant).Results: After we compared the three groups, there were no significant differences in variables between children with IKD and TKD, as well as CAL-KD and NCAL-KD, and IVIG sensitive KD and IVIG non-response KD. These include age, gender, day of illness, leukocytes count, serum levels of sodium, C-reactive protein, and albumin. The serum NT-proBNP level was higher in children of IKD than those TKD (1441±467.4 ng/L vs. 1049.0±283.4 ng/L, respectively), but not significant, higher in children with CAL than those NCAL (2608.2±745.5 ng/L vs. 902.6±162.0 ng/L, respectively), it is considered as a significant difference, and in IVIG non- response KD than those IVIG sensitive KD (1549±1943 ng/L vs. 1473±2961 ng/L, respectively), but no significant difference. Conclusion: The findings in this study show the serum NT-proBNP level is high in children with KD, it is may be useful to predict who risk to coronary artery lesions in Kawasaki disease