Pediatr Emerg Med J.  2019 Jun;6(1):11-16. 10.22470/pemj.2018.00304.

Comparison of acute phase reactant levels of Kawasaki disease patients who visited with less than 5 days duration of fever and with 5 days or longer

Affiliations
  • 1Department of Pediatrics, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea.
  • 2Department of Emergency Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea. pernoctans@gmail.com

Abstract

PURPOSE
Kawasaki disease (KD) is a common, acute systemic vasculitis in children. Acute phase reactants (APRs) have been used to assist diagnosis, and to predict outcome in children with KD. However, it remains unknown on levels of APRs depending on duration of fever. We aimed to compare APR levels of children with KD who visited with < 5 days duration of fever and with ≥ 5 days.
METHODS
Children (≤ 15 years) with complete KD who visited the emergency department were enrolled from March 2012 through February 2018. The children were divided into the early (fever < 5 days) and late (fever ≥ 5 days) presenters. The baseline characteristics, APR levels, such as platelet count, and outcomes were compared between the 2 groups.
RESULTS
A total of 145 children with complete KD were enrolled. Median age was 27.0 (interquartile range [IQR], 12.0-46.5) months, and boys accounted for 60.0%. The early presenters (63 [43.4%]) had a younger age (17.0 [IQR, 7.0-45.0] vs. 32.5 [IQR, 14.0-48.0] months; P = 0.006), shorter duration of fever (3.0 [IQR, 2.0-4.0] vs. 6.0 [IQR, 5.0-7.0] days; P < 0.001), and a lower platelet count (336.7 ± 105.2 [× 10³/µL] vs. 381.6 ± 121.8 [× 10³/µL], P = 0.02) than the late presenters. The other APR levels, and frequency of resistance to intravenous immunoglobulin and coronary artery abnormalities showed no differences between the 2 groups.
CONCLUSION
Children with KD who visited with < 5 days duration of fever had a lower platelet count compared to those with ≥ 5 days. No differences were found in the other APR levels and the outcomes. It may be necessary to consider the differences in APR levels depending on duration of fever when treating children with KD.

Keyword

Blood Platelets; C-Reactive Protein; Fever; Leukocyte Count; Mucocutaneous Lymph Node Syndrome

MeSH Terms

Acute-Phase Proteins
Blood Platelets
C-Reactive Protein
Child
Coronary Vessels
Diagnosis
Emergency Service, Hospital
Fever*
Humans
Immunoglobulins
Leukocyte Count
Mucocutaneous Lymph Node Syndrome*
Platelet Count
Systemic Vasculitis
Acute-Phase Proteins
C-Reactive Protein
Immunoglobulins
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