B-type natriuretic peptide and N-terminal pro-BNP in the acute phase of Kawasaki disease

This study was undertaken to identify factors correlating with plasma levels of B-type natriuretic peptide (BNP) and its N-terminal portion (NTpro BNP) in the acute phase of Kawasaki disease (KD). This study included 91 patients with KD treated at a hospital affiliated to Hamamatsu University School of Medicine between October 2003 and June 2011. We quantified BNP and NT-pro BNP in the acute phase. The BNP level was expressed as the NT-pro BNP level using the formula NT-pro BNP=9.080xBNP(0.923). We sought relationships between NT-pro BNP values and different clinical and laboratory data in the acute phase of KD. Of the 91 patients, 14 failed to respond to the initial intravenous immunoglobulins therapy. NTpro BNP levels were significantly higher in these nonresponders than in the responders (1689.3 +/- 1168.8 pg/ dL vs. 844.4 +/- 1276.3 pg/dL, P < 0.001). Seventeen patients developed coronary artery lesions, but this was not associated with NT-proBNP levels. NT-pro BNP was positively correlated with CRP (r=0.421, P < 0.001) and negatively correlated with the hematocrit (r=-0.206, P=0.050), Na value (r=-0.214, P=0.041) and albumin level (r=-0.345, P < 0.001). Stepwise multiple linear regression analysis with NT-pro BNP as a dependent variable revealed significant correlations with CRP and albumin (beta=0.345, P=0.001; beta=-0.225, P=0.027). A high level of NT-pro BNP in acute phase KD is associated with systemic inflammatory responses and increased vascular permeability. The NT-pro BNP level is a useful marker to identify potential non-responders to IVIG among KD patients.