Usefulness of natriuretic peptide for the diagnosis of Kawasaki disease: A systematic review and meta-analysis

Kuan Ho Lin, Shy Shin Chang, Chin Wei Yu, Shen Che Lin, Shu Chun Liu, Hsiao Yun Chao, Meng Tse Gabriel Lee, Jiunn Yih Wu, Chien Chang Lee

Research output: Contribution to journalArticle

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Abstract

Objective: To examine the diagnostic value of serum B-type natriuretic peptide (BNP) in acute Kawasaki disease (KD). Design: Systematic review and meta-analysis. Data sources: A systematic literature search strategy was designed and carried out using MEDLINE, EMBASE and the Cochrane Library from inception to December 2013. We also performed manual screening of the bibliographies of primary studies and review articles, and contacted authors for additional data. Study eligibility criteria: We included all BNP and NT-pro (N-terminal prohormone) BNP assay studies that compared paediatric patients with KD to patients with febrile illness unrelated to KD. We excluded case reports, case series, review articles, editorials, congress abstracts, clinical guidelines and all studies that compared healthy controls. Primary and secondary outcome measures: The performance characteristics of BNP were summarised using forest plots, hierarchical summary receiver operating characteristic (ROC) curves and bivariate random effects models. Results: We found six eligible studies including 279 cases of patients with KD and 203 febrile controls. Six studies examined NT-proBNP and one examined BNP. In general, NT-proBNP is a specific and moderately sensitive test for identifying KD. The pooled sensitivity was 0.89 (95% CI 0.78 to 0.95) and the pooled specificity was 0.72 (95% CI 0.58 to 0.82). The area under the summary ROC curve was 0.87 (95% CI 0.83 to 0.89). The positive likelihood ratio (LR+ 3.20, 95% CI 2.10 to 4.80) was sufficiently high to be qualified as a rule-in diagnostic tool in the context of high pre-test probability and compatible clinical symptoms. A high degree of heterogeneity was found using the Cochran Q statistic. Conclusions: Current evidence suggests that NT-proBNP may be used as a diagnostic tool for KD. NT-proBNP has high diagnostic value for identifying KD in patients with protracted undifferentiated febrile illness. Prospective large cohort studies are needed to help determine best cut-off values and further clarify the role of NT-proBNP in the diagnosis process of KD.

Original languageEnglish
Article numbere006703
JournalBMJ Open
Volume5
Issue number4
DOIs
Publication statusPublished - Jan 1 2015
Externally publishedYes

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Natriuretic Peptides
Mucocutaneous Lymph Node Syndrome
Meta-Analysis
Brain Natriuretic Peptide
Fever
ROC Curve
Information Storage and Retrieval
Bibliography
Acute Disease
MEDLINE
Libraries
Cohort Studies
Outcome Assessment (Health Care)
pro-brain natriuretic peptide (1-76)
Guidelines
Pediatrics
Serum

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Usefulness of natriuretic peptide for the diagnosis of Kawasaki disease : A systematic review and meta-analysis. / Lin, Kuan Ho; Chang, Shy Shin; Yu, Chin Wei; Lin, Shen Che; Liu, Shu Chun; Chao, Hsiao Yun; Lee, Meng Tse Gabriel; Wu, Jiunn Yih; Lee, Chien Chang.

In: BMJ Open, Vol. 5, No. 4, e006703, 01.01.2015.

Research output: Contribution to journalArticle

Lin, Kuan Ho ; Chang, Shy Shin ; Yu, Chin Wei ; Lin, Shen Che ; Liu, Shu Chun ; Chao, Hsiao Yun ; Lee, Meng Tse Gabriel ; Wu, Jiunn Yih ; Lee, Chien Chang. / Usefulness of natriuretic peptide for the diagnosis of Kawasaki disease : A systematic review and meta-analysis. In: BMJ Open. 2015 ; Vol. 5, No. 4.
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abstract = "Objective: To examine the diagnostic value of serum B-type natriuretic peptide (BNP) in acute Kawasaki disease (KD). Design: Systematic review and meta-analysis. Data sources: A systematic literature search strategy was designed and carried out using MEDLINE, EMBASE and the Cochrane Library from inception to December 2013. We also performed manual screening of the bibliographies of primary studies and review articles, and contacted authors for additional data. Study eligibility criteria: We included all BNP and NT-pro (N-terminal prohormone) BNP assay studies that compared paediatric patients with KD to patients with febrile illness unrelated to KD. We excluded case reports, case series, review articles, editorials, congress abstracts, clinical guidelines and all studies that compared healthy controls. Primary and secondary outcome measures: The performance characteristics of BNP were summarised using forest plots, hierarchical summary receiver operating characteristic (ROC) curves and bivariate random effects models. Results: We found six eligible studies including 279 cases of patients with KD and 203 febrile controls. Six studies examined NT-proBNP and one examined BNP. In general, NT-proBNP is a specific and moderately sensitive test for identifying KD. The pooled sensitivity was 0.89 (95{\%} CI 0.78 to 0.95) and the pooled specificity was 0.72 (95{\%} CI 0.58 to 0.82). The area under the summary ROC curve was 0.87 (95{\%} CI 0.83 to 0.89). The positive likelihood ratio (LR+ 3.20, 95{\%} CI 2.10 to 4.80) was sufficiently high to be qualified as a rule-in diagnostic tool in the context of high pre-test probability and compatible clinical symptoms. A high degree of heterogeneity was found using the Cochran Q statistic. Conclusions: Current evidence suggests that NT-proBNP may be used as a diagnostic tool for KD. NT-proBNP has high diagnostic value for identifying KD in patients with protracted undifferentiated febrile illness. Prospective large cohort studies are needed to help determine best cut-off values and further clarify the role of NT-proBNP in the diagnosis process of KD.",
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AU - Lin, Shen Che

AU - Liu, Shu Chun

AU - Chao, Hsiao Yun

AU - Lee, Meng Tse Gabriel

AU - Wu, Jiunn Yih

AU - Lee, Chien Chang

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