[Note to myself, 1-29-2020: After reviewing the articles in this post, I believe that main article referenced in this post is not helpful to my future review of the topic. I’m not eliminating the post because doing so breaks links. Rather, I recommend to myself rereading the following instead:
- Links To And Excerpts From The Cribsiders’ Episode #16: Kawasaki Disease With Additional Resources. Posted on January 28, 2021 by Tom Wade MD
- I recommend my post for review rather than Episode #16 Kawasaki Disease because I’ve included in my post information from the 2017 AHA Kawasaki Guidelines.
- Fifteen-minute consultation: Kawasaki disease: how to distinguish from other febrile illnesses: tricks and tips [PubMed Abstract] [Full Text HTML] [Full Test PDF]. Arch Dis Child Educ Pract Ed. 2020 Jun;105(3):152-156.]
In this post I link to and excerpt from lead author Adriana Tremoulet’s article Novel data-mining approach identifies biomarkers for diagnosis of Kawasaki disease [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Pediatr Res. 2015 November; 78(5): 547–553.
Here are excerpts:
As Kawasaki disease (KD) shares many clinical features with other more common febrile illnesses and misdiagnosis, leading to a delay in treatment, increases the risk of coronary artery damage, a diagnostic test for KD is urgently needed. We sought to develop a panel of biomarkers that could distinguish between acute KD patients and febrile controls (FC) with sufficient accuracy to be clinically useful.
Plasma samples were collected from three independent cohorts of FC and acute KD patients who met the American Heart Association definition for KD and presented within the first 10 days of fever. The levels of 88 biomarkers associated with inflammation were assessed by Luminex bead technology. Unsupervised clustering followed by supervised clustering using a Random Forest model was used to find a panel of candidate biomarkers.
A panel of biomarkers commonly available in the hospital laboratory (absolute neutrophil count, erythrocyte sedimentation rate, alanine aminotransferase, γ-glutamyl transferase, concentrations of α-1-antitrypsin, C-reactive protein, and fibrinogen, and platelet count) accurately diagnosed 81-96% of KD patients in a series of three independent cohorts.
Conclusion: After prospective validation, this eight-biomarker panel may improve the recognition of KD.
The etiology of Kawasaki disease (KD), the leading cause of acquired heart disease in children, remains unknown, and there is no definitive diagnostic test (1). The diagnosis rests upon clinical criteria that are shared by other common pediatric illnesses (2). Clinical confusion can lead to a missed or delayed diagnosis, which increases the risk of coronary artery aneurysms (3, 4). Between 15 to 30% of KD patients do not meet complete clinical criteria and are defined as having “incomplete” KD, which further contributes to delayed diagnosis (3, 5–8). Treatment with intravenous immunoglobulin (IVIG) is effective in reducing the cardiovascular complications if administered within the first 10 days after the onset of fever (9). Without prompt treatment, approximately 25% of children with KD will develop coronary artery aneurysms, which can lead to myocardial infarction and other cardiovascular sequelae later in life. Thus, a diagnostic test for KD is urgently needed to help identify patients who require treatment.