Abstract
Background: Post-COVID multisystem hyperinflammatory syndrome in children (MISC) has clinical and laboratory similarities with Kawasaki disease (KD). Inflammatory markers like C-reactive protein (CRP), interleukin 6 (IL6) as well as N-terminal probrain natriuretic peptide (NT-proBNP) are elevated in both. This study attempts a comparative analysis of the 3 markers in an attempt at early differentiation for planning appropriate management.
Methodology: This analytical study conducted at the Institute of Child Health, Kolkata, India compared the levels of the above 3 markers at admission between 72 patients with KD, 30% of whom had coronary artery lesions (CALs) collected over a period of 18 months (Jan 2017-June 2018), with 71 MISC patients over a period of 6 months (July 2020-December 2020). The non-parametric Mann-Whitney U test was used to test for similarity in distributions of the samples of CRP, NT-proBNP and IL6 in KD and MISC patients using correction factor for similar ranks. The 3 parameters were compared using receiver operating characteristic (ROC) curve analysis.
Results: Mean IL6 value in KD was 83.22 pg/mL and in MISC 199.91 pg/mL, which was not found to be statistically significant (P = .322 > .05).However mean NT-proBNP (914.91 pg/mL) with CRP level (96.32 mg/L) in KD was significantly lower (P < .05 for both cases) than that in MISC (9141.16 pg/mL and 145.66 mg/L respectively). ROC analysis showed NT-proBNP has the best sensitivity and specificity in predicting MISC.
Conclusion: NT-proBNP and CRP are significantly higher among MISC patients; ROC analysis shows levels >935.7 pg/mL and >99.55 mg/L respectively might act as a guide to differentiate between them.
Keywords: C-reactive protein; Kawasaki disease; MISC; NT-proBNP; PIMS; interleukin 6.
【저자키워드】 C-reactive protein, interleukin 6, Kawasaki disease, NT-proBNP, PIMS, MISC, 【초록키워드】 children, India, inflammatory markers, peptide, IL6, C-reactive protein, CRP, interleukin 6, Laboratory, interleukin, Hyperinflammatory syndrome, ROC, Sensitivity and specificity, management, Comparative analysis, Child, Kawasaki disease, Patient, distribution, characteristic, NT-proBNP, Admission, child health, PIMS, ROC analysis, marker, Analysis, similarity, Coronary artery, best, receiver operating characteristic, lesion, guide, CRP level, Mann-Whitney U test, significantly lower, parameter, N-terminal, distributions, Kolkata, was used, collected, elevated, conducted, significantly higher, statistically significant, 【제목키워드】 IL-6, children, CRP, Patient, Inflammatory, syndrome,