DOI QR코드

DOI QR Code

Clinical implications in laboratory parameter values in acute Kawasaki disease for early diagnosis and proper treatment

  • Seo, Yu-Mi (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kang, Hyun-Mi (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Sung-Churl (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Yu, Jae-Won (Department of Pediatrics, Chungnam National University Hospital, School of Medicine, Chungnam National University) ;
  • Kil, Hong-Ryang (Department of Pediatrics, Chungnam National University Hospital, School of Medicine, Chungnam National University) ;
  • Rhim, Jung-Woo (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Han, Ji-Whan (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Kyung-Yil (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
  • 투고 : 2017.09.08
  • 심사 : 2017.10.26
  • 발행 : 2018.05.15

초록

Purpose: This study aimed to analyse laboratory values according to fever duration, and evaluate the relationship across these values during the acute phase of Kawasaki disease (KD) to aid in the early diagnosis for early-presenting KD and incomplete KD patients. Methods: Clinical and laboratory data of patients with KD (n=615) were evaluated according to duration of fever at presentation, and were compared between patients with and without coronary artery lesions (CALs). For evaluation of the relationships across laboratory indices, patients with a fever duration of 5 days or 6 days were used (n=204). Results: The mean fever duration was $6.6{\pm}2.3days$, and the proportions of patients with CALs was 19.3% (n=114). C-reactive proteins (CRPs) and neutrophil differential values were highest and hemoglobin, albumin, and lymphocyte differential values were lowest in the 6-day group. Patients with CALs had longer total fever duration, higher CRP and neutrophil differential values and lower hemoglobin and albumin values compared to patients without CALs. CRP, albumin, neutrophil differential, and hemoglobin values at the peak inflammation stage of KD showed positive or negative correlations each other. Conclusion: The severity of systemic inflammation in KD was reflected in the laboratory values including CRP, neutrophil differential, albumin, and hemoglobin. Observing changes in these laboratory parameters by repeated examinations prior to the peak of inflammation in acute KD may aid in diagnosis of early-presenting KD patients.

키워드

참고문헌

  1. Lee KY, Rhim JW, Kang JH. Kawasaki disease: laboratory findings and an immunopathogenesis on the premise of a "protein homeo- stasis system". Yonsei Med J 2012;53:262-75. https://doi.org/10.3349/ymj.2012.53.2.262
  2. Kawasaki T. Acute febrile mucocutaneous lymph node syndrome in young children with unique digital desquamation. Arerugi 1967;16:178-222.
  3. Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 1996;94:1379-85. https://doi.org/10.1161/01.CIR.94.6.1379
  4. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawa-saki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004;114:1708-33. https://doi.org/10.1542/peds.2004-2182
  5. Hwang JY, Lee KY, Rhim JW, Youn YS, Oh JH, Han JW, et al. Assessment of intravenous immunoglobulin non-responders in Kawasaki disease. Arch Dis Child 2011;96:1088-90. https://doi.org/10.1136/adc.2010.184101
  6. Kil HR, Yu JW, Lee SC, Rhim JW, Lee KY. Changes in clinical and laboratory features of Kawasaki disease noted over time in Daejeon, Korea. Pediatr Rheumatol Online J 2017;15:60. https://doi.org/10.1186/s12969-017-0192-y
  7. Research Committee on Kawasaki Disease. Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease. Tokyo (Japan): Ministry of Health and Welfare, 1984.
  8. Kang HJ, Kim GN, Kil HR. Changes of clinical characteristics and outcomes in patients with Kawasaki disease over the past 7 years in a single center study. Korean J Pediatr 2013;56:389-95. https://doi.org/10.3345/kjp.2013.56.9.389
  9. Rhim JW, Youn YS, Han JW, Lee SJ, Oh JH, Lee KY. Changes in Kawasaki disease during 2 decades at a single institution in Daejeon, Korea. Pediatr Infect Dis J 2014;33:372-5. https://doi.org/10.1097/INF.0000000000000123
  10. Kim GB, Han JW, Park YW, Song MS, Hong YM, Cha SH, et al. Epidemiologic features of Kawasaki disease in South Korea: data from nationwide survey, 2009-2011. Pediatr Infect Dis J 2014;33:24-7. https://doi.org/10.1097/INF.0000000000000010
  11. Kim GB, Park S, Eun LY, Han JW, Lee SY, Yoon KL, et al. Epidemiology and clinical features of Kawasaki disease in South Korea, 2012-2014. Pediatr Infect Dis J 2017;36:482-5. https://doi.org/10.1097/INF.0000000000001474
  12. Yu JJ. Diagnosis of incomplete Kawasaki disease. Korean J Pediatr 2012;55:83-7. https://doi.org/10.3345/kjp.2012.55.3.83
  13. Manlhiot C, Christie E, McCrindle BW, Rosenberg H, Chahal N, Yeung RS. Complete and incomplete Kawasaki disease: two sides of the same coin. Eur J Pediatr 2012;171:657-62. https://doi.org/10.1007/s00431-011-1631-2
  14. McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 2017;135:e927-99. https://doi.org/10.1161/CIR.0000000000000484
  15. Chung HS, Lee KY, Han JW, Cha SW, Lee DJ, Whang KT. Clinical analysis and comparison of Kawasaki disease between patients younger than one year of age and those over one year of age. J Korean Pediatr Soc 1999;42:936-42.
  16. Lee KY, Oh JH, Han JW, Lee JS, Lee BC. Arthritis in Kawasaki disease after responding to intravenous immunoglobulin treatment. Eur J Pediatr 2005;164:451-2. https://doi.org/10.1007/s00431-005-1653-8
  17. Lee KJ, Kim HJ, Kim MJ, Yoon JH, Lee EJ, Lee JY, et al. Usefulness of anterior uveitis as an additional tool for diagnosing incomplete Kawasaki disease. Korean J Pediatr 2016;59:174-7. https://doi.org/10.3345/kjp.2016.59.4.174
  18. Lee KY, Han JW, Hong JH, Lee HS, Lee JS, Whang KT. Inflammatory processes in Kawasaki disease reach their peak at the sixth day of fever onset: laboratory profiles according to duration of fever. J Korean Med Sci 2004;19:501-4. https://doi.org/10.3346/jkms.2004.19.4.501
  19. Kang JH, Hong SJ, Seo IA, Kwak MH, Cho SM, Kim DK, et al. Early detection of Kawasaki disease in infants. Korean Circ J 2015;45:510-5. https://doi.org/10.4070/kcj.2015.45.6.510
  20. Seo JH, Yu JJ, Ko HK, Choi HS, Kim YH, Ko JK. Diagnosis of incom- plete kawasaki disease in infants based on an inflammation at the bacille calmette-guérin inoculation site. Korean Circ J 2012;42:823-9. https://doi.org/10.4070/kcj.2012.42.12.823
  21. Choi HS, Lee SB, Kwon JH, Kim HS, Sohn S, Hong YM. Uveitis as an important ocular sign to help early diagnosis in Kawasaki disease. Korean J Pediatr 2015;58:374-9. https://doi.org/10.3345/kjp.2015.58.10.374
  22. Yellen ES, Gauvreau K, Takahashi M, Burns JC, Shulman S, Baker AL, et al. Performance of 2004 American Heart Association recommen- dations for treatment of Kawasaki disease. Pediatrics 2010;125:e234-41. https://doi.org/10.1542/peds.2009-0606
  23. Jun HO, Yu JJ, Kang SY, Seo CD, Baek JS, Kim YH, et al. Diagnostic characteristics of supplemental laboratory criteria for incomplete Kawasaki disease in children with complete Kawasaki disease. Korean J Pediatr 2015;58:369-73. https://doi.org/10.3345/kjp.2015.58.10.369
  24. Koren G, Lavi S, Rose V, Rowe R. Kawasaki disease: review of risk factors for coronary aneurysms. J Pediatr 1986;108:388-92. https://doi.org/10.1016/S0022-3476(86)80878-2
  25. Egami K, Muta H, Ishii M, Suda K, Sugahara Y, Iemura M, et al. Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease. J Pediatr 2006;149:237-40. https://doi.org/10.1016/j.jpeds.2006.03.050
  26. Kobayashi T, Inoue Y, Takeuchi K, Okada Y, Tamura K, Tomomasa T, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 2006;113:2606-12. https://doi.org/10.1161/CIRCULATIONAHA.105.592865
  27. Sano T, Kurotobi S, Matsuzaki K, Yamamoto T, Maki I, Miki K, et al. Prediction of non-responsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment. Eur J Pediatr 2007;166:131-7.
  28. Rigante D, Andreozzi L, Fastiggi M, Bracci B, Natale MF, Esposito S. Critical overview of the risk scoring systems to predict non-responsiveness to intravenous immunoglobulin in Kawasaki syndrome. Int J Mol Sci 2016;17:278. https://doi.org/10.3390/ijms17030278
  29. Fukunishi M, Kikkawa M, Hamana K, Onodera T, Matsuzaki K, Matsumoto Y, et al. Prediction of non-responsiveness to intravenous high-dose gamma-globulin therapy in patients with Kawasaki disease at onset. J Pediatr 2000;137:172-6. https://doi.org/10.1067/mpd.2000.104815
  30. Seo E, Yu JJ, Jun HO, Shin EJ, Baek JS, Kim YH, et al. Prediction of unresponsiveness to second intravenous immunoglobulin treatment in patients with Kawasaki disease refractory to initial treatment. Korean J Pediatr 2016;59:408-13. https://doi.org/10.3345/kjp.2016.59.10.408
  31. Newburger JW, Sleeper LA, McCrindle BW, Minich LL, Gersony W, Vetter VL, et al. Randomized trial of pulsed corticosteroid therapy for primary treatment of Kawasaki disease. N Engl J Med 2007;356:663- 75. https://doi.org/10.1056/NEJMoa061235
  32. Tewelde H, Yoon J, Van Ittersum W, Worley S, Preminger T, Goldfarb J. The Harada score in the US population of children with Kawasaki disease. Hosp Pediatr 2014;4:233-8. https://doi.org/10.1542/hpeds.2014-0008
  33. Takahashi T, Sakakibara H, Morikawa Y, Miura M. Development of coronary artery lesions in indolent Kawasaki disease following initial spontaneous defervescence: a retrospective cohort study. Pediatr Rheumatol Online J 2015;13:44. https://doi.org/10.1186/s12969-015-0042-8
  34. Lee KY. A common immunopathogenesis mechanism for infectious diseases: the protein-homeostasis-system hypothesis. Infect Chemother 2015;47:12-26. https://doi.org/10.3947/ic.2015.47.1.12
  35. Han JW, Oh JH, Rhim JW, Lee KY. Correlation between elevated platelet count and immunoglobulin levels in the early convalescent stage of Kawasaki disease. Medicine (Baltimore) 2017;96:e7583. https://doi.org/10.1097/MD.0000000000007583

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