Elevated levels of NT-proBNP, interferon-γ and tumor necrosis factor-α are associated with coronary artery injury in children with severe Kawasaki disease.

Objective: To investigate the association between N-terminal pro-brain natriuretic peptide (NT-proBNP), interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), and coronary artery injury in children with Kawasaki disease (KD).

Methods: This retrospective study included 42 children with KD admitted to Baoding Hospital of Beijing Children's Hospital Capital Medical University from January 2019 to January 2022 (KD group), and 80 healthy children during the same period (control group). Peripheral blood markers including white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hb), hematocrit (HCT), mean platelet volume (MPV), platelet distribution width (PDW), platelet count (PLT), NT-proBNP, IFN-γ, TNF-α, C-reactive protein (CRP), and circulating endothelial cell count (CEC) were compared between groups. KD patients were further stratified based on the severity of coronary artery involvement for subgroup analysis.

Results: Compared with the control group, the KD group showed significantly higher levels of WBC, PDW, PLT, NT-proBNP, IFN-γ, TNF-α, CRP, and CEC, and significantly lower levels of RBC, Hb, and HCT (all P < 0.05). MPV levels did not differ significantly between groups (P > 0.05). Among the 42 KD patients, 17 had coronary artery involvement. These patients exhibited significantly higher levels of PDW, NT-proBNP, IFN-γ, TNF-α, CRP, and CEC compared to those without coronary artery injury (all P < 0.05). There were no significant differences in WBC, RBC, Hb, HCT, MPV, or PLT between the KD subgroups with and without coronary artery lesions (all P > 0.05). The diagnostic sensitivity of NT-proBNP, IFN-γ, and TNF-α for coronary artery injury in KD was 96.18%, 83.47%, and 65.20%, respectively, with specificities of 78.71%, 82.16%, and 81.98%, respectively. The area under the ROC curve for NT-proBNP, IFN-γ, and TNF-α was 0.969, 0.875, and 0.704, respectively. Logistic regression analysis identified elevated IFN-γ, TNF-α, CRP, and CEC as independent risk factors for coronary artery injury in children with KD (all P < 0.05).

Conclusions: NT-proBNP, IFN-γ, and TNF-α levels are significantly elevated in children with severe KD and are closely associated with coronary artery injury. These biomarkers may serve as early predictors of coronary artery complications in KD.