Authors
Jinquan Liu, Jiaojiao Wan, Kaiyu Zhou, Yimin Hua, Mei Wu, Lei Liu, Xiaoliang Liu, Chuan Wang, Hongyu Duan, Shuran Shao
Published in
European journal of pediatrics. Volume 185. Issue 10. Sep 08, 2026. Epub Sep 08, 2026.
Abstract
Kawasaki disease shock syndrome (KDSS) is a severe phenotype of Kawasaki disease (KD) characterized by hemodynamic instability and systemic inflammation. Early identification of children at risk for KDSS remains challenging. N-terminal pro-B-type natriuretic peptide (NT-proBNP) reflects cardiovascular stress and has been associated with severe manifestations of KD; however, its interpretation in children is complicated by age dependency. This study aimed to evaluate the predictive utility of baseline NT-proBNP, compare raw NT-proBNP concentrations with age-adjusted NT-proBNP z-scores, and assess their performance relative to other routinely available laboratory biomarkers for KDSS prediction. A total of 588 KD patients were finally enrolled in this prospective cohort study between January 2015 and March 2021. The demographic/clinical characteristics and laboratory data were compared between the patients with KDSS (KDSS group, n = 35) and those without (KD group, n = 553). NT-proBNP concentrations were analyzed as both raw values and age-adjusted z-scores calculated using established pediatric reference ranges. Multivariable logistic regression models were constructed using baseline variables, with log10-transformed NT-proBNP and NT-proBNP z-score evaluated in separate models. Receiver operating characteristic (ROC) analyses were performed to compare predictive performance among NT-proBNP-related parameters and other candidate biomarkers. Children in the KDSS group were older than those in the non-KDSS group (66.11 ± 47.06 vs. 31.36 ± 23.57 months, P < 0.001). KDSS patients had significantly higher rates of coronary artery lesions (40.0% vs. 11.6%, P < 0.001) and intravenous immunoglobulin (IVIG) resistance (51.5% vs. 12.5%, P < 0.001), while classic clinical manifestations such as bilateral conjunctival injection (74.3% vs. 92.8%, P = 0.001) and oral mucosal erythema (77.1% vs. 93.1%, P = 0.004) were less frequent. Regarding laboratory parameters, KDSS patients exhibited significantly higher neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), creatinine, and NT-proBNP, but significantly lower lymphocyte-to-C-reactive protein ratio (LCR), hemoglobin, platelet count, hematocrit, sodium, and potassium levels compared with non-KDSS patients. Multivariate logistic regression identified older age, higher NT-proBNP (both raw and age-standardized Z-score), lower platelet, hemoglobin, and rates of erythema of oral and pharyngeal mucosa as independent predictors of KDSS. ROC analysis showed that the raw NT-proBNP cutoff of 1354 pg/mL gave an AUC of 0.71 (95% CI 0.61-0.81), with sensitivity of 74.3% and specificity of 64.2%, and age-standardized NT-proBNP Z-score had an AUC of 0.73 (95% CI 0.63-0.83), with an optimal cutoff of ≥ 3.3 yielding a sensitivity of 74.3% and specificity of 65.8%.
NT-proBNP might be a complementary laboratory marker for the prediction of KDSS in KD.
• NT-proBNP concentrations are age-dependent in children, but most previous studies of KDSS have relied on absolute NT-proBNP concentrations without age-standardized interpretation.
• Baseline NT-proBNP was independently associated with KDSS, and age-adjusted NT-proBNP z-scores showed comparable predictive performance, supporting NT-proBNP as an adjunctive marker for early KDSS risk stratification after consideration of age dependency.
PMID:
42711435
Bibliographic data and abstract were imported from PubMed on 09 Sep 2026.
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