Eur J Pediatr. 2026 Feb 18;185(3):137. doi: 10.1007/s00431-026-06792-y.
ABSTRACT
Kawasaki disease (KD) is an acute vasculitis affecting medium-sized vessels and characterized by fever lasting more than 5 days. Differential diagnosis of KD is challenging. Microribonucleic acids (miRNA/miR) have been widely studied as potential biomarkers for diagnosing KD. The objective of this study is to systematically review the clinical utility of miRNAs in KD. This systematic review followed the PRISMA 2020 guidelines. We included English-language, full-text observational studies enrolling adult and/or pediatric patients with KD (complete or incomplete) which quantified miRNA expression levels or genotyped single-nucleotide polymorphisms (SNPs) in miRNA genes. We searched the following databases: Embase, Medline Ultimate, PubMed, Scopus, and Web of Science. Each database was last searched on January 12, 2026. Thirty-six studies met the eligibility criteria and were included in this review. The most reproducible finding concerns miR-223 which has been repeatedly reported to be upregulated in KD patients compared with both healthy and febrile controls. Several miRNAs have been described to distinguish specific KD phenotypes, e.g., coronary artery lesion (CAL) formation and intravenous immunoglobulin (IVIG) responsiveness. The majority of investigated SNPs in miRNA genes were not associated with KD susceptibility; however, some associations were reported, including with KD phenotypes such as CAL formation.Conclusions: Multiple studies have shown dysregulation of miRNA expression in KD patients and the potential utility of miRNAs in diagnosing KD and identifying individuals at risk of CAL formation or IVIG resistance. Nevertheless, there is a need for methodological standardization in future research and for studies including multiethnic cohorts. What's Known? • No single test for Kawasaki Disease is available; it can be diagnosed in patients meeting the clinical criteria. • Microribonucleic acids are promising biomarkers in various cardiovascular conditions including Kawasaki Disease. What's New? • To the best of our knowledge, this is the first systematic review evaluating microribonucleic acids in Kawasaki Disease using PRISMA guidelines. • Studies regarding the role of microribonucleic acids in Kawasaki Disease are highly heterogeneous but several of them display significant potential as diagnostic biomarkers.
PMID:41709025 | DOI:10.1007/s00431-026-06792-y