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

Yoon Suk Lee; Jihyen Lee; Young Mi Hong; Sejung Sohn

doi:10.14776/piv.2016.23.1.25

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Lee, Lee, Hong, and Sohn: C-reactive Protein and Erythrocyte Sedimentation Rate Discrepancies and Variations after Intravenous Immunoglobulin Therapy in Kawasaki Disease

Review Article

Pediatr Infect Vaccine 2016;23(1):25-30.

Published online: 21 January 2016

DOI: https://doi.org/10.14776/piv.2016.23.1.25

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

Yoon Suk Lee, Jihyen Lee, Young Mi Hong, Sejung Sohn

Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea

Correspondence: Sejung Sohn Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea Tel: +82-2-2650-5579, Fax: +82-2-2653-3718 E-mal: sohﬂ@evvha.ac.kr

Received 26 August 201519 October 2015 Accepted 23 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 KB 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 210 mg/dL and ESR <50 mm/ hr (Group 1), 0r CRP <10 mg/dL and ESR 250 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 25 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 (34.31210 mm/hr vs. 26.3:193 mm/hr, P=0.029). After IVIG treatment, elevated WBC count, % neutrophils, CRP, and NT—proBNP levels normalized. In contrast, ESR increased from 37_4i21_9 mm/hr t0 48.0i22.7 mm/hr (n=36, P:0.0S1).

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 |V|G treatment. After IVIG treatment, the ESR should not be used as a marker of response to therapy in KD.

Keywords: Kawasaki disease, C-reactive protein, Erythrocyte sedimentation rate

REFERENCES

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Fig. 1.

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

Table 1.

Comparison of Basic Characteristics between Groups 1 and 2

	Group 1 (n=25)	Group 2 (n=11)	P
Age (months)	36.3±201	45.0±28.4	0.301
Sex (maIe/female)	12/13	3/8	0.154
Height (cm)	95.5±166	100.3±14.0	0.412
Weight (kg)	14.6±5.0	14.3±5.3	0.892
Duration of fever (days)	4.5±16.6	4.7±2.0	0741
CRP (mg/GL)	15.1±4.6	6.0±2.2	<0.001
ESR (mm/hr)	27.7±122	63.3±10.7	<0.001

Abbreviations: IVIG Intravenous Immunoglobulin; CRP, L-reactive protein; ESR, erythrocyte sedimentation rate. Data are expressed as mean±SD or number. Group 1 includes 25 patients with CRP 210 mg/dL and ESR <50 mm/hr, and group 2 includes 11 patients with CRP <10 mg/dL and ESR≥50 mm/hr at presentation.

Table 2.

Relationship between Fever Duration and Groups

	Group1CRP ≥1O mg/dL and ESR <50 mm/hr	Group 2 CRP <10 mg/dL and ESR ≥50 mm/hr
Fever duration <5 days	15	6
Fever duration ≥5 days	10	5
Total	25	11

Abreviations: CRP, C-reactive protein; ESR, erythrocyte sedimentation rate. Data are expressed as number.

Table 3.

Comparison between the Early and Late Presenters in 123 patients

	Early presenters (Fever duration <5 days)	Late presenters (Fever duration 25 days)	P
Age (months)	27.4 ±18.2	32.7±22.4	0.154
Sex (male/female)	37/31	29/26	0.858
CRP (mg/dL)	8.7±5.8	7.8±5.7	0.359
ESR (mm/hr)	26.3±19.3	34.3±21.0	0.029

Abbreviation: CRP, C-reactlve proteln; ESR, erythrocyte sedlmentatlon rate. Data are expressed as mean±SD or number.

Table 4.

Comparison between Pre- and Post-Intravenous Immunoglobulin Laboratory Values in 123 patients

	Pre-IVIG	Post-IVIG	p
WBC (/mm³)	13,769±4,269	8,267±2,769	<0.001
% neutrophils	62.9±154	35.1±17.Z	<0.001
Hemoglobln (g/dL)	11.3 ±1.0	11.0± 1.0	<0.001
Hematocrit (%)	33.2±2.7	32.5±2.7	0.007
PIatelet (x10³/mm)	336±92	433±134	<0.001
Sodium (mEq/L)	136.8±2.6	136.2±9.9	0.564
AST (IU/L)	114±252	121±342	0.826
ALT (IU/L)	104±185	107±301	0.728
Protein (g/dL)	6.6±0.5	7.8±0.7	<0.001
AIbumin (g/dL)	3.8±0.4	3.3±03	<0.001
CRP (mg/dL)	8.3±5.8	1.5±1.3	<0.001
NT-proBNP (pg/mL)	1,212±2,398	300±511	<0.001

Abbreviations: IVIG, intravenous immunoglobulin; WBC, white blood cell; AST, as-partate aminotrasferase; ALTalanine aminotrasferase; CRP, C-reactive protein; NT-proBNP, N-terminal pro—brain natriuretic peptide. Data are expressed as mean±SD.

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