Pediatr Gastroenterol Hepatol Nutr.  2015 Mar;18(1):39-47. 10.5223/pghn.2015.18.1.39.

Laboratory Markers Indicating Gastrointestinal Involvement of Henoch-Schonlein Purpura in Children

• Hong J
• Yang HR

• KMID: 2315534
• DOI: http://doi.org/10.5223/pghn.2015.18.1.39

Abstract

PURPOSE
To determine clinically useful biochemical markers reflecting disease activity and/or gastrointestinal (GI) tract involvement in Henoch-Schonlein purpura (HSP).
METHODS
A total of 185 children with HSP and 130 controls were included. Laboratory data indicating inflammation, standard coagulation, and activated coagulation were analyzed for the HSP patients, including measurements of the hemoglobin level, white blood cell (WBC) count, absolute neutrophil count (ANC), platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, prothrombin time, activated partial thromboplastin time, and fibrinogen, D-dimer, and fibrin degradation product (FDP) levels. The clinical scores of the skin, joints, abdomen, and kidneys were assessed during the acute and convalescence phases of HSP.
RESULTS
The WBC count, ANC, ESR, and CRP, fibrinogen, D-dimer, and FDP levels were significantly higher in the acute phase compared with the convalescent phase of HSP (p<0.05). The total clinical scores were more strongly correlated with the D-dimer (r=0.371, p<0.001) and FDP (r=0.369, p<0.001) levels than with inflammatory markers, such as the WBC count (r=0.241, p=0.001), ANC (r=0.261, p<0.001), and CRP (r=0.260, p<0.001) levels. The patients with GI symptoms had significantly higher ANC (median [interquartile range], 7,138.0 [4,446.4-9,470.0] vs. 5,534.1 [3,263.0-8,153.5], p<0.05) and CRP (0.49 [0.15-1.38] vs. 0.23 [0.01-0.67], p<0.05), D-dimer (2.63 [1.20-4.09] vs. 1.75 [0.62-3.39]), and FDP (7.10 [0.01-13.65] vs. 0.10 [0.01-7.90], p<0.05) levels than those without GI symptoms.
CONCLUSION
D-dimer and FDPs are more strongly associated with disease activity and more consistently reflect GI involvement than inflammatory markers during the acute phase of HSP.

Keyword

Purpura; Schonlein-Henoch; Blood coagulation; Inflammation; Fibrin fibrinogen degradation products; Fibrin fragment D; Child

MeSH Terms

Abdomen
Biomarkers*
Blood Coagulation
Blood Sedimentation
C-Reactive Protein
Child*
Convalescence
Fibrin
Fibrin Fibrinogen Degradation Products
Fibrinogen
Humans
Inflammation
Joints
Kidney
Leukocytes
Neutrophils
Partial Thromboplastin Time
Platelet Count
Prothrombin Time
Purpura
Purpura, Schoenlein-Henoch*
Skin
C-Reactive Protein
Fibrin
Fibrin Fibrinogen Degradation Products
Fibrinogen

Figure

• 

  Fig. 1 Comparison of the levels of (A) fibrinogen, (B) D-dimer and (C) fibrin degradation products (FDPs) among the patients of acute phase, convalescent phase, and healthy controls. The fibrinogen, D-dimer, and FDP levels during the acute phase of the patients were significantly higher than during the convalescent phase and those in the control group (p<0.05).

• 

  Fig. 2 Comparison of the levels of (A) white blood cell (WBC), (B) absolute neutrophil count (ANC), (C) C-reactive protein (CRP), (D) D-dimer, and (E) fibrin degradation products (FDPs) among the patients categorized according to the abdominal score of Henoch-Schönlein purpura. The ANC, CRP, D-dimer, and FDP levels were significantly higher in the patients with gastrointestinal (GI) symptoms (abdominal scores of 1-3) than those without GI symptoms (abdominal score of 0) (p<0.05). The patients with significant GI symptoms (abdominal scores of 2-3) had higher WBC counts, ANC, CRP, D-dimer, and FDP levels than those without GI symptoms (abdominal score of 0) (p<0.05). GI symptom: no, abdominal score 0; mild, abdominal score 1; significant, abdominal score 2-3.

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