Procalcitonin (PCT) and Kawasaki Disease: Does PCT Correlate With IVIG-Resistant Disease, Admission to the Intensive Care Unit, or Development of Coronary Artery Lesions?

Dominguez, Samuel R.; Martin, Blake; Heizer, Heather; Jone, Pei‐Ni; Tong, Suhong; Davidson, Jesse; Anderson, Marsha S.; Glodé, Mary P.

doi:10.1093/jpids/piv019

Cited by 33 publications

(31 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lower serum albumin levels have previously been correlated with IVIG- unresponsiveness and CALs[33]. Our laboratory findings documented that during the acute phase of the disease serum albumin was significantly lower and PLT higher in patients with abdominal manifestations.…”

Section: Discussionsupporting

confidence: 76%

Gastrointestinal presentation of Kawasaki disease: A red flag for severe disease?

et al. 2018

View full text Add to dashboard Cite

BackgroundKawasaki disease (KD) is a febrile systemic vasculitis of unknown etiology and the main cause of acquired heart disease among children in the developed world. To date, abdominal involvement at presentation is not recognized as a risk factor for a more severe form of the disease.ObjectiveTo evaluate whether presenting abdominal manifestations identify a group at major risk for Intravenous immunoglobulin (IVIG)-resistance and coronary lesions.MethodsRetrospective study of KD patients diagnosed between 2000 and 2015 in 13 pediatric units in Italy. Patients were divided into 2 groups according to the presence or absence of abdominal manifestations at onset. We compared their demographic and clinical data, IVIG-responsiveness, coronary ectasia/aneurysms, laboratory findings from the acute and subacute phases.Results302 patients (181 boys) were enrolled: 106 patients with, and 196 patients without presenting abdominal features. Seasonality was different between the groups (p = 0.034). Patients with abdominal manifestations were younger (p = 0.006) and more frequently underwent delayed treatment (p = 0.014). In the acute phase, patients with abdominal presentation had higher platelet counts (PLT) (p = 0.042) and lower albuminemia (p = 0.009), while, in the subacute phase, they had higher white blood cell counts (WBC) and PLT (p = 0.002 and p < 0.005, respectively) and lower red blood cell counts (RBC) and hemoglobin (Hb) (p = 0.031 and p 0.009). Moreover, the above mentioned group was more likely to be IVIG-resistant (p < 0.005) and have coronary aneurysms (p = 0.007). In the multivariate analysis, presenting abdominal manifestations, age younger than 6 months, IVIG- resistance, delayed treatment and albumin concentration in the acute phase were independent risk factors for coronary aneurysms (respectively p<0.005, <0.005, = 0.005 and 0.009).ConclusionsThis is the first multicenter report demonstrating that presenting gastrointestinal features in KD identify patients at higher risk for IVIG-resistance and for the development of coronary aneurysms in a predominantly Caucasian population.Clinical trial registration8/20014/O/OssN.

show abstract

Section: Discussionsupporting

confidence: 76%

Gastrointestinal presentation of Kawasaki disease: A red flag for severe disease?

et al. 2018

View full text Add to dashboard Cite

show abstract

“…PCT has been documented as a marker of bacterial infection. However, PCT also mediates the inflammatory response; for example, high serum PCT levels have been reported in patients with Kawasaki disease [16] or with invasive trauma [4]. By contrast, the values of P-SEP do not show a similar elevation, even in patients with trauma [4].…”

Section: Discussionmentioning

confidence: 99%

Serum Procalcitonin and Presepsin Levels in Patients with Generalized Pustular Psoriasis

et al. 2018

View full text Add to dashboard Cite

Patients with generalized pustular psoriasis (GPP) often present with symptoms that must be differentiated from sepsis. Procalcitonin (PCT) and presepsin (P-SEP) are widely used as biomarkers for sepsis; therefore, we examined the serum PCT and P-SEP levels in patients with psoriatic diseases. The enrolled patients included 27 with psoriasis vulgaris (PV) (22 males, 5 females; mean age 47.7 years), 12 with psoriatic arthritis (PsA) (8 males, 4 females; mean age 51.3 years), and 15 with GPP (10 males, 5 females; mean age 63.7 years). The mean serum PCT levels in patients with PV, PsA, and GPP were 0.01 ng/mL (25th–75th percentile; 0.00–0.03), 0.013 ng/mL (0.00–0.03), and 0.12 ng/mL (0.05–0.18), respectively; the levels of PCT were higher for patients with GPP than with PV or PsA but were lower than the PCT cutoff value (0.5 ng/mL) for the diagnosis of infection. The mean serum P-SEP levels in patients with PV, PsA, and GPP were 144.9 pg/mL (25th–75th percentile; 78–181), 168.1 pg/mL (124–203), and 479.9 pg/mL (216–581), respectively. Unexpectedly, the levels of P-SEP in the patients with GPP were as high as the P-SEP cutoff value (317 to 647 pg/mL) used for the diagnosis of infection. We also found that neutrophils produced P-SEP, suggesting that the high serum P-SEP levels in patients with GPP might arise at least in part due to the P-SEP derived from neutrophils activated in GPP. Both serum PCT and P-SEP might therefore be useful as novel serum biomarkers for GPP because their levels were decreased by GPP treatments. However, the measurement of PCT might be more useful than the measurement of P-SEP for discriminating between GPP and sepsis.

show abstract

“…We recruited the following laboratory data before IVIG: white blood cell (WBC) count, neutrophil count, hemoglobin (Hb), PLT count, T-Bil, albumin, AST, ALT, Na, CRP, D-dimer, brain natriuretic peptide, and FC levels. Some of these factors were previously reported to be useful in predicting unresponsiveness to IVIG [1][2][3][4][5][6][7][8][9] and can be always measured in most hospitals. According to the 2018 Japanese guide for the diagnosis and treatment of carnitine de ciency [14], low, normal, and high FC were de ned as serum FC level < 36 µmol/L , 36 µmol/L £ FC £ 74 µmol/L, and FC > 74 µmol/L, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…In patients at high risks of unresponsiveness to IVIG, steroid combination therapy with IVIG is used to avoid CAL. In previous studies, several factors have been suggested as a biomarker that could predict unresponsiveness to IVIG, such as neutrophil counts, Creactive protein (CRP) and procalcitonin levels [1,2,3,4,5,6]. In Japan, Gunma, Kurume, and Osaka scores are commonly used to predict unresponsiveness to IVIG [7,8,9].…”

Section: Introductionmentioning

confidence: 99%

Elevated Serum Free Carnitine Levels in Children with Kawasaki Disease and Their Relation to Unresponsiveness to Intravenous Immunoglobulin: retrospective study

Muto¹,

Nakamura²,

Masuda³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Carnitine plays an essential role in transfer of long-chain fatty acids to mitochondria for subsequent β-oxidation. No studies to date have characterized carnitine in children with KD. The objective of this study is to investigate the characteristics of serum free carnitine (FC) in hospitalized pediatric patients with Kawasaki disease (KD). Methods: In total, 45 patients with KD measured the levels of serum FC from October 2018 to December 2019 were analyzed retrospectively. We analyzed the clinical and laboratory parameters just before the Intravenous immunoglobulin (IVIG) including serum levels of serum FC with respect to the IVIG response. We also analyzed the relationship between serum FC and liver deviation enzymes or the duration of fever at diagnosis. Results: The median age was 33 months. IVIG was effective in 33 children (responders) and was ineffective in 12 (non-responders). The serum FC levels were higher in non-responders than in responders [(35.3 mmol/L (range, 26.8-118.4 mmol/L) vs. 31.4 mmol/L (range, 20.9-81.2 mmol/L), p value = 0.0496]. The FC levels before intravenous immunoglobulin (IVIG) in four-fifths of responders were below the normal range. The levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and FC were higher in non-responders than in responders. There were no different in patient characteristics and laboratory data according to fever duration at diagnosis. There was a correlation between FC and AST (R2=0.364, P=0.0015) and between FC and ALT (R2=0.423, P<0.001) levels. Conclusion: FC levels were upregulated in patients with KD who were refractory to IVIG. Additionally, FC levels in children with KD correlated with AST and ALT levels. The pathogenesis resulting in the elevation of FC levels remains elusive. Further studies are necessary to understand more precisely carnitine properties in patients with KD.

show abstract

Procalcitonin (PCT) and Kawasaki Disease: Does PCT Correlate With IVIG-Resistant Disease, Admission to the Intensive Care Unit, or Development of Coronary Artery Lesions?

Abstract: Additional research is needed to establish the sensitivity and specificity of PCT for the diagnosis of KD. PCT may be of value in predicting which children are at increased risk for IVIG-resistant disease.

Cited by 33 publications

References 28 publications

Gastrointestinal presentation of Kawasaki disease: A red flag for severe disease?

Gastrointestinal presentation of Kawasaki disease: A red flag for severe disease?

Serum Procalcitonin and Presepsin Levels in Patients with Generalized Pustular Psoriasis

Elevated Serum Free Carnitine Levels in Children with Kawasaki Disease and Their Relation to Unresponsiveness to Intravenous Immunoglobulin: retrospective study

Contact Info

Product

Resources

About