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Usefulness of natriuretic peptide for the diagnosis of Kawasaki disease: a systematic review and meta-analysis
  1. Kuan-Ho Lin1,2,
  2. Shy-Shin Chang3,4,
  3. Chin-Wei Yu5,6,
  4. Shen-Che Lin5,7,
  5. Shu-Chun Liu5,7,
  6. Hsiao-yun Chao5,7,
  7. Meng-tse Gabriel Lee8,
  8. Jiunn-Yih Wu5,6,
  9. Chien-Chang Lee8,9,10
  1. 1College of Medicine, China Medical University, Taichung, Taiwan
  2. 2Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
  3. 3Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
  4. 4Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
  5. 5Chang Gung University College of Medicine, Taoyuan, Taiwan
  6. 6Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
  7. 7Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
  8. 8Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
  9. 9Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
  10. 10Department of Epidemiology, Harvard School of Public Health, Boston, USA
  1. Correspondence to Dr Jiunn-Yih Wu; and Dr Chien-Chang Lee; cclee100{at}


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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