Pediatr Infect Vaccine.  2016 Apr;23(1):25-30. 10.14776/piv.2016.23.1.25.

C-reactive Protein and Erythrocyte Sedimentation Rate Discrepancies and Variations after Intravenous Immunoglobulin Therapy in Kawasaki Disease

• Lee YS
• Lee J
• Hong YM
• Sohn S

• KMID: 2163220
• DOI: http://doi.org/10.14776/piv.2016.23.1.25

Abstract

PURPOSE
We undertook this study to investigate discrepancies in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values, and variations following intravenous immunoglobulin (IVIG) therapy in Kawasaki disease (KD).
METHODS
A total of 123 KD patients were retrospectively enrolled. Patients were treated with IVIG 2 g/kg at 2 to 9 days after disease onset. We obtained white blood cell (WBC) count, percentage of neutrophils (% neutrophils), CRP, ESR, and N-terminal pro-brain natriuretic peptide (NT-proBNP) values before and 48 to 72 hours after IVIG treatment. Discrepancy was defined as CRP ≥10 mg/dL and ESR <50 mm/hr (Group 1), or CRP <10 mg/dL and ESR ≥50 mm/hr (Group 2).
RESULTS
Thirty-six of 123 subjects (29.2%) had a discrepancy: 25 (20.3%) in Group 1 and 11 (8.9%) in Group 2. In Group 1, 15 patients (60%) had fever for <5 days (early presenter) and 10 (40%) had fever for ≥5 days (late presenter). There were six early presenters (55%) and five late presenters (45%) in Group 2. Late presenters had higher ESR than early presenters (34.3±21.0 mm/hr vs. 26.3±19.3 mm/hr, P=0.029). After IVIG treatment, elevated WBC count, % neutrophils, CRP, and NT-proBNP levels normalized. In contrast, ESR increased from 37.4±21.9 mm/hr to 48.0±22.7 mm/hr (n=36, P=0.051).
CONCLUSIONS
A discrepancy may be related to the duration of fever. Due to discrepancies in CRP and ESR values in acute KD, both should be measured to assess the degree of inflammatory activity before IVIG treatment. After IVIG treatment, the ESR should not be used as a marker of response to therapy in KD.

Keyword

Kawasaki disease; C-reactive protein; Erythrocyte sedimentation rate

MeSH Terms

Blood Sedimentation*
C-Reactive Protein*
Erythrocytes*
Fever
Humans
Immunization, Passive*
Immunoglobulins*
Immunoglobulins, Intravenous
Leukocytes
Mucocutaneous Lymph Node Syndrome*
Neutrophils
Retrospective Studies
C-Reactive Protein
Immunoglobulins
Immunoglobulins, Intravenous

Figure

• 

  Fig. 1. Comparison of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at presentation.

Reference

1. Lee H, Kim H, Kim HS, Sohn S. NT-proBNP: a new diagnostic screening tool for Kawasaki disease. Korean I Pediatr. 2006; 49:539–44.

2. Anderson MS, Burns I, Treadwell TA, Pietra BA, Glode MP. Erythrocyte sedimentation rate and C-reactive protein discrepancy and high prevalence of coronary artery abnormalities in Kawasaki disease. Pediatr Infect Dis J. 2001; 20:698–702.

3. Dajani AS, Taubert KA, Gerber MA, Shulman ST, Ferrieri P, Freed M, et al. Diagnosis and therapy of Kawasaki disease in children. Circulation. 1993; 87:1776–80.

4. Lee G, Lee SE, Hong YM, Sohn S. Is high-dose aspirin necessary in the acute phase of Kawasaki disease? Korean Circ J. 2013; 43:182–6.

5. 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.

6. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns IC, et al. Diagnosis, treatment, and longterm management of Kawasaki 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. Circulation. 2004; 110:2747–71.

7. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Jpn I Allergy. 1967; 16:178–222.

8. Young B, Gleeson M, Cripps AW. C-reactive protein: a critical review. Pathology. 1991; 23:118–24.

9. Kim HK, Oh 1, Hong YM, Sohn S. Parameters to guide retreatment after initial intravenous immunoglobulin therapy in Kawasaki disease. Korean Circ I. 2011; 41:379–84.

10. de Zorzi A, Colan SD, Gauvreau K, Baker AL, Sundel RP, Newburger IW. Coronary artery dimensions may be mis-classified as normal in Kawasaki disease. I Pediatr. 1998; 133:254–8.