J Korean Soc Emerg Med.  2018 Feb;29(1):37-43. 10.0000/jksem.2018.29.1.37.

Role of N-terminal Pro-brain Natriuretic Peptide in Differentiating Node-first Presentations of Kawasaki Disease and Bacterial Cervical Lymphadenitis

• Hwang IW
• Lee DW
• Kim JW
• Park SH
• Lee JW
• Moon HJ
• Choi JH
• Lee HJ
• Jung YH
• Kim HS
• Jun DH

• KMID: 2435565
• DOI: http://doi.org/10.0000/jksem.2018.29.1.37

Abstract

PURPOSE
Kawasaki disease (KD) is an acute, self-limited, febrile disease. For cases of KD in which the first symptom is cervical lymphadenopathy (node-first presentations of KD, NFKD), it is frequently misdiagnosed as bacterial cervical lymphadenitis (BCL). Therefore, we evaluated the usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) to differentiate between NFKD and BCL.
METHODS
This is a retrospective, observational study. Patients were divided into three groups, KD as 1st diagnosis, NFKD, and BCL. The laboratory and demographic data, intravenous immunoglobulin (IVIG) administration time and total febrile duration, length of hospital stay, and number of coronary artery complications were then compared for each group.
RESULTS
A total of 451 patients were diagnosed as KD and 45 patients as BCL. Of the 451 KD patients, 417 (92.5%) were KD as 1st diagnosis, and 34 (7.5%) were NFKD. White blood cell count, absolute neutrophil count, C-reactive protein, erythrocyte sedimentation rate, and NT-proBNP differed significantly between NFKD and BCL. Variables that differed significantly were analyzed using a receiver operating characteristic curve, which revealed that NT-proBNP had the largest area under curve (0.944). Additionally, IVIG administration time, total febrile duration and length of hospital stay differed between KD as 1st diagnosis and NFKD.
CONCLUSION
It is difficult to differentiate NFKD from BCL, so proper treatment and length of hospital stay were delayed. NT-proBNP is very useful for differentiating NFKD and BCL. Therefore, in cases of BCL with a long febrile period without reacting general treatments, the NT-proBNP test can be considered.

Keyword

Mucocutaneous lymph node syndrome; Lymphadenitis; Diagnosis; differential

MeSH Terms

Area Under Curve
Blood Sedimentation
C-Reactive Protein
Coronary Vessels
Diagnosis
Humans
Immunoglobulins
Immunoglobulins, Intravenous
Length of Stay
Leukocyte Count
Lymphadenitis*
Lymphatic Diseases
Mucocutaneous Lymph Node Syndrome*
Neutrophils
Observational Study
Retrospective Studies
ROC Curve
C-Reactive Protein
Immunoglobulins
Immunoglobulins, Intravenous