Differentiation of COVID-19-Associated Multisystem Inflammatory Syndrome From Kawasaki Disease With the Use of Cardiac Biomarkers.
Differentiation of COVID-19-Associated Multisystem Inflammatory Syndrome From Kawasaki Disease With the Use of Cardiac Biomarkers.
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DOI：
10.1016/j.cjca.2022.11.012
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发表时间：
2023-06
影响因子：
6.2
通讯作者：
McCrindle, Brian W.
中科院分区：
文献类型：
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作者：
Fridman, Michael D.;Tsoukas, Paul;Jeewa, Aamir;Yeung, Rae S. M.;Gamulka, Beth D.;McCrindle, Brian W.
COVID-19后儿童多系统炎症综合征（MIS-C）与川崎（KD）具有临床相似性。我们试图确定心脏生物标志物水平是否区分MIS-C和KD及其与心脏受累的关系。受试者包括38名确诊既往COVID-19的MIS-C患者和32名大流行前患者以及38名同期无COVID-19证据的KD患者。提取心脏生物标志物评估后72小时内的患者、临床、超声心动图、心电图和实验室数据。对各组进行比较，并使用回归分析来确定生物标志物水平、诊断和心脏受累之间的相关性，并对临床因素进行调整。MIS-C患者的KD临床特征较少，休克、重症监护室入院、正性肌力药需求和心室功能障碍更频繁，冠状动脉受累无差异。多变量回归分析显示，在调整显著协变量后，较高的N末端B型利钠肽前体（NT-proBNP）和心肌肌钙蛋白I（TnI）与MIS-C vs KD相关。受试者工作特征曲线显示，任何可检测到的TnI大于10 ng/L，均能预测MIS-C vs KD，敏感性为91%，特异性为76%。NT-proBNP > 2000 ng/L预测MIS-C vs KD的敏感性和特异性分别为82%和82%。较高的TnI而非NT-proBNP与较低的LV射血分数相关。两种生物标志物均与冠状动脉受累无关。阳性TnI和较高的NT-proBNP可以区分MIS-C和KD，随着既往COVID-19的证据变得更加难以确定，这可能变得更加相关。在这种情况下，心脏生物标志物与心脏受累的相关性可能有限。
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.
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影响因子：
5.4
作者：
Clark BC;Sanchez-de-Toledo J;Bautista-Rodriguez C;Choueiter N;Lara D;Kang H;Mohsin S;Fraisse A;Cesar S;Sattar Shaikh A;Escobar-Diaz MC;Hsu DT;Randanne PC;Aslam N;Kleinmahon J;Lamour JM;Johnson JN;Sarquella-Brugada G;Chowdhury D
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作者：
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通讯作者：
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