Analysis of the relationship between serum BNP,cTnⅠ,and the efficacy of intravenous immunoglobulin therapy in children with Kawasaki disease

LIU Xiao-dong; JIANG Ming

doi:10.3969/j.issn.1009-8933.2025.04.006

Abstract：Background: Kawasaki disease (KD) is a common acute systemic vasculitis in children, with coronary artery injury being its most serious complication. Currently, intravenous immunoglobulin (IVIG) serves as the standard first-line treatment. However, approximately 10%-20% of patients do not respond to initial IVIG therapy, leading to difficulties in inflammation control, increased risk of coronary artery lesions, and a lack of reliable early predictive indicators. Existing scoring systems (such as the Kobayashi and Egami scores) for predicting IVIG nonresponse are predominantly based on clinical features and conventional inflammatory markers, and thus have limited ability to specifically reflect the extent of myocardial involvement and cardiac functional impairment. Therefore, identifying biomarkers capable of predicting IVIG responsiveness is of significant importance for clinical decision making and improving patients' outcomes. Brain natriuretic peptide (BNP) and cardiac troponin I (cTnI), which reflect cardiac function and myocardial injury respectively, may serve as potential indicators for evaluating IVIG treatment response. Combining these two cardiac-specific biomarkers with traditional scoring systems could provide a more comprehensive and accurate tool for early identification of IVIG nonresponsive patients. Methods: A retrospective analysis was conducted on the clinical data of 80 children with KD who were admitted to Longyan First Hospital from January 2024 to October 2025. All patients received IVIG therapy. Based on treatment response, they were divided into an IVIG-responsive group and an IVIG-nonresponsive group. General information and laboratory parameters were collected from both groups. Univariate and multivariate logistic regression analyses were employed to screen for independent risk factors affecting the efficacy of IVIG in KD patients. Additionally, receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of BNP and cTnI for IVIG treatment response. Results: After standard IVIG treatment, all KD children were categorized based on treatment response into an IVIG-responsive group (n=68, 85.00%) and an IVIG-nonresponsive group (n=12, 15.00%). The Kobayashi score, ESR, BNP, and cTnI levels were significantly higher in the IVIG-nonresponsive group compared to the IVIG-responsive group (P<0.05). Multivariate logistic regression analysis identified Kobayashi score, BNP, and cTnI as independent risk factors affecting IVIG treatment efficacy. Furthermore, ROC curve analysis demonstrated that both BNP and cTnI exhibited predictive value for IVIG treatment outcomes. Conclusions: The Kobayashi score, serum BNP level, and serum cTnⅠ level were all independent risk factors influencing the efficacy of IVIG therapy in children with KD. Both serum BNP and cTnⅠ levels demonstrated certain predictive value for IVIG treatment outcomes.