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

Abstract

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.

Risk Factors of Intravenous Immunoglobulin Resistance in Children With Kawasaki Disease: A Meta-Analysis of Case-Control Studies

“…Firstly, the presence of confounding factors may reduce the accuracy of prediction and treatment guidance. The intensity of KD inflammation gradually increases in the acute stage and reach the peak, then decreases and enters to the convalescent stage (44), and the immune reaction before the peak may be responsible for tissue cell injury while immune reaction after the peak may be responsible for tissue cell repair (38), so inflammatory indices change throughout this process over time. Obviously, fever duration is a confounding factor predicting IVIG resistance.…”

Kawasaki Disease Following Severe Sunburn Injury

“…KD is a self-limiting disease, even in patients with KD who have severe CALs (15). During the self-limiting clinical course of KD, the intensity of systemic inflammation in the acute febrile stage of KD gradually increases and reaches a peak (mean 6th day of fever onset) (16). After the acute febrile stage, inflammation gradually decreases and the disease progresses to the convalescent stage (16).…”

“…During the self-limiting clinical course of KD, the intensity of systemic inflammation in the acute febrile stage of KD gradually increases and reaches a peak (mean 6th day of fever onset) (16). After the acute febrile stage, inflammation gradually decreases and the disease progresses to the convalescent stage (16). Thus, it has been postulated that the host immune reactions preceding this peak of inflammation process mediates tissue cell injury, whereas the immune reactions following the peak mediate tissue cell repair.…”

Adjuvant herbal therapy for targeting susceptibility genes to Kawasaki disease: An overview of epidemiology, pathogenesis, diagnosis and pharmacological treatment of Kawasaki disease

“…Although with standardized diagnostic criteria compiled, due to variability of clinical symptoms in different cases, discrepancies in the interpretation of clinical signs and symptoms have led to undiagnosed and unreported cases of KD (Ayusawa et al, 2005;Daniels et al, 2012). However, recent report has suggested the evaluation on the systemic inflammatory parameters such as Creactive protein (CRP), neutrophil differential, albumin and hemoglobin in the early phrase of acute KD, are critical for the early diagnosis of KD (Seo et al, 2018).…”