Predicting recalcitrant hyperinflammatory disease course in children with Kawasaki disease and MIS-C
Authors' conclusion
NT-proBNP, IL-2R, and SAA were strongly associated with a recalcitrant hyperinflammatory course and may aid early prognostication and monitoring.
Study context
- Population
- Consecutive children with hyperinflammation (Kawasaki disease and MIS-C), single centre, 01/2021–01/2024
- Participants
- 80 children
- Exposure
- Recalcitrant vs monophasic hyperinflammatory course
- Recalcitrantn = 56
- Outcome
- Baseline biomarkers predicting recalcitrant course (ROC analyses)
- Follow-up
- Baseline
Methodological detailssingle-centre, consecutive patients, All received IVIG; steroids and anakinra used only in recalcitrant cases
- Single-centre
- Consecutive patients
- All received IVIG; steroids and anakinra used only in recalcitrant cases
Main finding
As reported in the abstract
- NT-proBNP AUC
- 0.912
- IL-2R AUC
- 0.873
- SAA AUC
- 0.793
- All AUCs P
- p < 0.001
Observational data: associations, not effects.
Further findings
Coronary artery changes
ICU admission
P < 0.01
- Recalcitrant course (incidence)
- 70% · 56
Clinical and laboratory features
- Rash, mucosal involvement and conjunctivitis more common in monophasic; abdominal pain, neurological signs, pleural effusion, lymphopenia, thrombocytopenia, hypoalbuminemia and elevated ferritin characterised recalcitrant (p < 0.01)
- Myocarditis and reduced ejection fraction only in recalcitrant
- Recalcitrant had longer hospital stays and required inotropes/ventilation
Mortality
- All survived
Original publication
Predicting recalcitrant hyperinflammatory disease course in children with Kawasaki disease and MIS-C. Pediatr Rheumatol Online J. Published 24 March 2026. doi:10.
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