Correlation between elevated platelet count and immunoglobulin levels in the early convalescent stage of Kawasaki disease

Han, Ji-Whan; Oh, Jin-Hee; Rhim, Jung-Woo; Lee, Kyung-Yil

doi:10.1097/md.0000000000007583

Cited by 22 publications

(19 citation statements)

References 25 publications

(36 reference statements)

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“…Additionally, serum IL-21 levels may be regulated by IgG levels [45]. In the present study, we observed lower levels of serum IgG and higher expression levels of IL-21 in the AP, while in the RP the IgG levels were shown to increase [47] and IL-21 levels decreased. Nevertheless, further analysis indicated no correlation between serum levels of IL-21 and IgG in the AP.…”

Section: Discussionsupporting

confidence: 53%

Variation in IL-21-secreting circulating follicular helper T cells in Kawasaki disease

Jiang

Zhang

et al. 2018

BMC Immunol

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ObjectiveCirculating follicular helper T (cTfh) cells are a specialized subset of CD4+ T cells that express the CXC-chemokine receptor 5 (CXCR5). These cells exhibit immune activities by inducing B cell differentiation and proliferation via the secretion of interleukin (IL)-21. Multiple studies have demonstrated that cTfh cells are associated with the progression and severity of numerous diseases. To investigate the role of cTfh cells in the development of Kawasaki disease (KD), we analyzed the distinct subpopulations of cTfh cells and serum IL-21 levels in different phases of KD.MethodsAccording to the differential expression of inducible co-stimulator (ICOS) and programmed cell death protein 1 (PD-1), cTfh cells were divided into distinct subsets. We used flow cytometry and flow cytometric bead arrays (CBA) to analyze subsets of CD4+CXCR5+ T cells and serum IL-21 levels. The samples were collected from control subjects and Kawasaki disease patients in the acute and remission phases.ResultsIn the acute phase (AP), the percentages of ICOShighPD-1high, ICOS+PD-1+, ICOS−PD-1+, CD45RA−IL-21+ cTfh cells and serum IL-21 levels significantly increased. Furthermore, the percentages of ICOShighPD-1high and ICOS+PD-1+ cTfh cells positively correlated with erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values, whereas the percentage of ICOS−PD-1+ cTfh cells indicated negative correlations. The percentages of ICOS+PD-1+, ICOShighPD-1high and CD45RA−IL-21+ cTfh cells correlated positively with serum IL-21 levels. In the remission phase (RP), the percentages of ICOS−PD-1+, CD45RA−IL-21+ cTfh cells and serum IL-21 levels were significantly decreased. In contrast, the percentages of ICOS+PD-1+, ICOShighPD-1high, and ICOS+PD-1− cTfh cells were further increased. Among these subsets, only CD45RA−IL-21+ cTfh cells correlated positively with serum IL-21 levels.ConclusionsThe present study is the first investigation that examined the distribution of circulating cTfh cell subsets in Kawasaki disease. Both cTfh cells and serum IL-21 are essential to the pathogenesis of KD. Our study provides further understanding of the immune response involved in KD and offers novel insights in the pathogenetic mechanism of this disease.Electronic supplementary materialThe online version of this article (10.1186/s12865-018-0282-8) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 53%

Variation in IL-21-secreting circulating follicular helper T cells in Kawasaki disease

Jiang

Zhang

et al. 2018

BMC Immunol

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“…Therefore, confirmation of this characteristic of KD inflammation could be helpful for KD patient selection after IVIG treatment. 35) …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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PurposeThis 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.MethodsClinical 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).ResultsThe mean fever duration was 6.6±2.3 days, 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.ConclusionThe 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.

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“…Interestingly, in children with systemic vasculitides, particularly Kawasaki disease (KD), platelet counts may predict disease outcomes at various stages. An increase in platelet count accompanied by an increase in lymphocyte count, a decrease in neutrophil count, and amelioration of immunoglobulin G, M, and A levels suggests a good response to intravenous immunoglobulin and aspirin therapy at the early, in-hospital stages of convalescence in KD [14]. However, persistently high platelet counts may indicate a complicated course and the development of coronary aneurysms in KD [15].…”

Section: Introductionmentioning

confidence: 99%

The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases

et al. 2019

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The platelet-to-lymphocyte ratio (PLR) has emerged as an informative marker revealing shifts in platelet and lymphocyte counts due to acute inflammatory and prothrombotic states. PLR has been extensively examined in neoplastic diseases accompanied by immune suppression and thrombosis, which can be predicted by combined blood cell counts and their ratios. Several large observational studies have demonstrated the value of shifts in PLR in evaluating the severity of systemic inflammation and predicting infections and other comorbidities, in inflammatory rheumatic diseases. The value of PLR as an inflammatory marker increases when its fluctuations are interpreted along with other complementary hematologic indices, particularly the neutrophil-to-lymphocyte ratio (NLR), which provides additional information about the disease activity, presence of neutrophilic inflammation, infectious complications, and severe organ damage in systemic lupus erythematosus. PLR and NLR have high predictive value in rheumatic diseases with predominantly neutrophilic inflammation (e.g., Behçet disease and familial Mediterranean fever). High PLR, along with elevated platelet count, is potentially useful in diagnosing some systemic vasculitides, particularly giant-cell arteritis. A few longitudinal studies on rheumatic diseases have demonstrated a decrease in PLR in response to anti-inflammatory therapies. The main limitations of PLR studies are preanalytical faults, inadequate standardization of laboratory measurements, and inappropriate subject selection. Nonetheless, accumulating evidence suggests that PLR can provide valuable information to clinicians who encounter multisystem manifestations of rheumatic diseases, which are reflected in shifts in platelet, lymphocyte, neutrophil, or monocyte counts. Interpretation of PLR combined with complementary hematologic indices is advisable to more accurately diagnose inflammatory rheumatic diseases and predict related comorbidities.

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Correlation between elevated platelet count and immunoglobulin levels in the early convalescent stage of Kawasaki disease

Cited by 22 publications

References 25 publications

Variation in IL-21-secreting circulating follicular helper T cells in Kawasaki disease

Variation in IL-21-secreting circulating follicular helper T cells in Kawasaki disease

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

The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases

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