Promising biomarkers in acute Kawasaki disease and acute coronary ischemia

Abstract

There are no specific biomarkers to confirm a diagnosis of Kawasaki disease (KD) or predict nonresponse to immunoglobulin therapy (IVIG) or development of coronary artery lesions (CAL). Among the many abnormal laboratory findings in acute KD, only some biomarkers are useful for diagnosis, assessment of the risk of IVIG nonresponse, and determining the likelihood of CAL formation. Instead of a single marker, characteristic profiles may be examined. High levels of C-reactive protein (CRP), pentraxin-3, serum amyloid A, urinary beta microglobulin, brain natriuretic protein (BNP), and N-type (NT)-pro BNP and low serum albumin and sodium levels are together suggestive of KD and a high likelihood of IVIG nonresponse and CAL formation. In addition, levels of many inflammatory cytokines are elevated in acute KD. Simultaneous evaluation of multiple cytokines has recently become possible. Some characteristic cytokine expression patterns for auto-inflammatory diseases such as KD, systemic juvenile arteritis, and periodic fever syndrome have been described. An IL-6–dominant cytokine profile pattern is characteristic of KD, and cytokine profiling is promising in KD diagnosis. However, several days are required to obtain the results of these tests, and this is a significant drawback for a potential biomarker. There are, however, reliable biomarkers for detecting myocardial injury. Creatine kinase (CK), CK-MB, myoglobin, heart-type fatty acid–binding protein, myocardial troponin I and T, and myosin light chain are established markers of myocardial injury in adults and can be also be used in the assessment of children. Myocardial infarction without specific symptoms sometimes occurs in children. In such cases, cytokine markers are useful for detecting early myocardial infarction. Although no specific biomarkers are present for KD, some characteristic overall laboratory findings are useful for clinical decision-making and are considered relevant biomarkers. To select appropriate treatment strategies, it is important to assess a patient’s condition by incorporating multiple laboratory findings with physical findings.