Baseline NT-proBNP, both as raw concentrations and age-adjusted z-scores, was independently associated with KDSS and may serve as a complementary laboratory marker for early prediction of Kawasaki disease shock syndrome.
KDSS patients were significantly older than non-KDSS KD patients.
KDSS patients had significantly higher rates of coronary artery lesions and IVIG resistance compared to non-KDSS patients.
Classic Kawasaki disease clinical manifestations were less frequent in KDSS patients than in non-KDSS patients.
Multiple laboratory parameters were significantly different between KDSS and non-KDSS patients.
Raw NT-proBNP concentrations were independently associated with KDSS and demonstrated moderate predictive performance on ROC analysis.
Age-adjusted NT-proBNP z-scores showed comparable predictive performance to raw NT-proBNP concentrations for KDSS prediction.
Multivariate logistic regression identified older age, higher NT-proBNP (both raw and z-score), lower platelet count, lower hemoglobin, and absence of oral/pharyngeal mucosal erythema as independent predictors of KDSS.
This research suggests that a blood marker called NT-proBNP, which reflects stress on the heart and blood vessels, can help doctors identify children with Kawasaki disease who are at risk of developing a serious complication called Kawasaki disease shock syndrome (KDSS). KDSS involves dangerous drops in blood pressure and can be difficult to spot early. In a study of 588 children with Kawasaki disease followed over six years, children who developed KDSS had significantly higher NT-proBNP levels, were older, had higher rates of coronary artery damage and resistance to standard treatment, and paradoxically showed fewer of the classic visible symptoms of Kawasaki disease such as red eyes and mouth sores. An important contribution of this study is that it compared standard NT-proBNP blood levels to age-adjusted scores (z-scores), since normal NT-proBNP values naturally vary with a child's age. Both approaches performed similarly in identifying KDSS risk, with an optimal raw cutoff of 1354 pg/mL and an age-adjusted z-score cutoff of 3.3 or higher, each providing roughly 74% sensitivity and 65% specificity. This means neither measure alone is perfect, but both add useful information alongside other laboratory tests such as platelet count and hemoglobin. This research suggests that routinely measuring NT-proBNP at the time of Kawasaki disease diagnosis, and interpreting it in an age-appropriate context, could help clinicians flag higher-risk children earlier for closer monitoring and more aggressive treatment. The findings highlight that children who present with atypical or less obvious symptoms of Kawasaki disease may still be at elevated risk of shock, and that a combination of clinical and laboratory markers is likely needed for the best prediction of this serious complication.
Liu J, Wan J, Zhou K, Hua Y, Wu M, Liu L, et al.. (2026). The role of N-terminal probrain natriuretic peptide in predicting Kawasaki disease shock syndrome: a prospective cohort study.. European journal of pediatrics. https://doi.org/10.1007/s00431-026-07390-8