Differentiation of COVID-19–Associated Multisystem Inflammatory Syndrome From Kawasaki Disease With the Use of Cardiac Biomarkers
Multisystem inflammatory syndrome in children (MIS-C) after COVID-19 shares clinical similarities to Kawasaki disease (KD). We sought to determine whether cardiac biomarker levels differentiate MIS-C from KD and their association with cardiac involvement. Subjects included 38 MIS-C patients with con...
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| Published in: | Canadian journal of cardiology 2023-06, Vol.39 (6), p.815-823 |
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| Main Authors: | , , , , , |
| Format: | Article |
| Language: | eng |
| Online Access: | Get full text |
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| Summary: | Multisystem inflammatory syndrome in children (MIS-C) after COVID-19 shares clinical similarities to Kawasaki disease (KD). We sought to determine whether cardiac biomarker levels differentiate MIS-C from KD and their association with cardiac involvement.
Subjects included 38 MIS-C patients with confirmed prior COVID-19 and 32 prepandemic and 38 contemporaneous KD patients with no evidence of COVID-19. Patient, clinical, echocardiographic, electrocardiographic, and laboratory data timed within 72 hours of cardiac biomarker assessment were abstracted. Groups were compared, and regression analyses were used to determine associations between biomarker levels, diagnosis and cardiac involvement, adjusting for clinical factors.
MIS-C patients had fewer KD clinical features, with more frequent shock, intensive care unit admission, inotrope requirement, and ventricular dysfunction, with no difference regarding coronary artery involvement. Multivariable regression analysis showed that both higher N-terminal pro–B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (TnI) were associated with MIS-C vs KD, after adjusting for significant covariates. Receiver operating characteristic curves for diagnosis showed that any detectable TnI greater than 10 ng/L was predictive of MIS-C vs KD with 91% sensitivity and 76% specificity. NT-proBNP > 2000 ng/L predicted MIS-C vs KD with 82% sensitivity and 82% specificity. Higher TnI but not NT-proBNP was associated with lower LV ejection fraction. Neither biomarker was associated with coronary artery involvement.
Positive TnI and higher NT-proBNP may differentiate MIS-C from KD, which may become more relevant as evidence of prior COVID-19 becomes more challenging to determine. Cardiac biomarkers may have limited associations with cardiac involvement in this setting.
Le syndrome inflammatoire multisystémique chez les enfants (SIME) lié à la COVID-19 partage des caractéristiques cliniques avec la maladie de Kawasaki (MK). Nous avons tenté de déterminer si les concentrations de biomarqueurs cardiaques permettent de différencier le SIME de la MK et d’établir un lien avec l’atteinte cardiaque.
La population à l’étude comprenait 38 patients atteints du SIME ayant eu une infection confirmée par la COVID-19, et 32 et 38 patients ne présentant aucun signe de COVID-19 atteints de la MK respectivement avant la pandémie et au moment de l’analyse. Les caractéristiques des patients, les données cliniques, échocardiographiques et électro |
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| ISSN: | 0828-282X 1916-7075 |