Usefulness of natriuretic peptide for the diagnosis of Kawasaki disease: a systematic review and meta-analysis.
Bottom Line: We found six eligible studies including 279 cases of patients with KD and 203 febrile controls.A high degree of heterogeneity was found using the Cochran Q statistic.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.
Affiliation: College of Medicine, China Medical University, Taichung, Taiwan Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.Show MeSH
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Mentions: Results of the meta-analysis indicated that PCT testing has an acceptable accuracy regarding differentiating KD from other causes of prolonged febrile illness (table 3). The pooled sensitivity and specificity estimates were 0.89 (95% CI 0.79 to 0.95) and 0.77 (95% CI 0.62 to 0.88), respectively. When the analysis was restricted to six studies measuring NT-proBNP, there is no change in sensitivity (0.89, 95% CI 0.78 to 0.95) but a slight decrease in specificity (0.72, 95% CI 0.58 to 0.82). The positive likelihood ratio (LR+, 3.20, 95% CI 2.10 to 4.80) of NT-proBNP is not sufficient for a standalone rule-in test. The negative likelihood ratio (LR−, 0.15, 95% CI 0.07 to 0.31), in the context of low pretest probability (<10%), could reduce the post-test probability to such a level that KD could be safely excluded. To take within and between study variation into account, we constructed HSROC and forest plot for NT-proBNP, which derived an area under the curve (AUC) of 0.87 (95% CI 0.83 to 0.89) and a summary OR of 21.6 (95% CI 8.33 to 55.97), respectively (figures 3 and 4). According to Hosmer and Lemeshow, our AUC of between 0.80 and 0.90 can be regarded as ‘good’.22 High statistical heterogeneity was also noted, but the Galbraith plots did not indicate a major outlier, which, for the most part, could account for the observed heterogeneity.23 Results of Eggers tests are presented in table 3, but the small number of studies may prevent a meaningful exam of publication bias.
Affiliation: College of Medicine, China Medical University, Taichung, Taiwan Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.