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Wang Y, Cao Y, Li Y, Zhu F, Yuan M, Xu J, Ma X, Li J. Development of an immunoinflammatory indicator-related dynamic nomogram based on machine learning for the prediction of intravenous immunoglobulin-resistant Kawasaki disease patients. Int Immunopharmacol 2024; 134:112194. [PMID: 38703570 DOI: 10.1016/j.intimp.2024.112194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Approximately 10-20% of Kawasaki disease (KD) patients suffer from intravenous immunoglobulin (IVIG) resistance, placing them at higher risk of developing coronary artery aneurysms. Therefore, we aimed to construct an IVIG resistance prediction tool for children with KD in Shanghai, China. METHODS Retrospective analysis was conducted on data from 1271 patients diagnosed with KD and the patients were randomly divided into a training set and a validation set in a 2:1 ratio. Machine learning algorithms were employed to identify important predictors associated with IVIG resistance and to build a predictive model. The best-performing model was used to construct a dynamic nomogram. Moreover, receiver operating characteristic curves, calibration plots, and decision-curve analysis were utilized to measure the discriminatory power, accuracy, and clinical utility of the nomogram. RESULTS Six variables were identified as important predictors, including C-reactive protein, neutrophil ratio, procalcitonin, CD3 ratio, CD19 count, and IgM level. A dynamic nomogram constructed with these factors was available at https://hktk.shinyapps.io/dynnomapp/. The nomogram demonstrated good diagnostic performance in the training and validation sets (area under the receiver operating characteristic curve = 0.816 and 0.800, respectively). Moreover, the calibration curves and decision curves analysis indicated that the nomogram showed good consistency between predicted and actual outcomes and had good clinical benefits. CONCLUSION A web-based dynamic nomogram for IVIG resistance was constructed with good predictive performance, which can be used as a practical approach for early screening to assist physicians in personalizing the treatment of KD patients in Shanghai.
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Affiliation(s)
- Yue Wang
- Clinical Laboratory Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Yinyin Cao
- Cardiovascular Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Yang Li
- Clinical Laboratory Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Fenhua Zhu
- Clinical Laboratory Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Meifen Yuan
- Clinical Laboratory Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Jin Xu
- Clinical Laboratory Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Xiaojing Ma
- Cardiovascular Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Jian Li
- Clinical Laboratory Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
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Chen J, Liao J, Xiang L, Zhang S, Yan Y. Current knowledge of TNF-α monoclonal antibody infliximab in treating Kawasaki disease: a comprehensive review. Front Immunol 2023; 14:1237670. [PMID: 37936712 PMCID: PMC10626541 DOI: 10.3389/fimmu.2023.1237670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
Kawasaki disease (KD), an autoinflammatory disease primarily affecting young children, characterized by consisting of acute systemic vasculitis and coronary artery involvement in severe cases. Intravenous immunoglobulin gamma (IVIG) combined with aspirin therapy is the first-line regimen for the prevention of coronary aneurysms in the acute phase of KD. The etiology and pathogenesis of KD are unclear, but its incidence is increasing gradually, especially in the cases of IVIG-naïve KD and refractory KD. Conventional therapies for refractory KD have unsatisfactory results. At present, infliximab (IFX), a human-murine chimeric monoclonal antibody that specifically blocks tumor necrosis factor-α (TNF-α), has made great progress in the treatment of KD. This review revealed that IFX infusion (5 mg/kg) could effectively modulate fever, reduce inflammation, improve arthritis, diminish the number of plasma exchange, decrease hospitalizations, and prevent the progression of coronary artery lesions. The adverse effects of IFX administration included skin rash, arthritis, respiratory disease, infusion reaction, hepatomegaly, and vaccination-associated complications. But the incidence of these adverse effects is low. The clear optimal application protocol of the application of IFX for either initial combination therapy or salvage therapy in KD is still under investigation. In addition, there are no effective biomarkers to predict IFX resistance. Further multicenter trials with large sample size and long-term follow-up are still needed to validate the clinical efficacy and safety of IFX for IVIG-resistant KD or refractory KD.
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Affiliation(s)
- Jiaying Chen
- Department of Pediatrics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Jian Liao
- Department of Nephrology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, Zhejiang, China
| | - Lupeng Xiang
- Taizhou University Medical School, Taizhou, Zhejiang, China
| | - Shilong Zhang
- Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yajing Yan
- Health Management Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
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Iio K, Hanna H, Beykou M, Gale C, Herberg JA. Role of procalcitonin in predicting complications of Kawasaki disease. Arch Dis Child 2023; 108:862-864. [PMID: 37524408 DOI: 10.1136/archdischild-2023-325787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Kazuki Iio
- Applied Paediatrics MSc course, Imperial College London, London, UK
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Heather Hanna
- Section of Paediatric Infectious Disease, Imperial College London, London, UK
| | - Melina Beykou
- Circuits and Systems Group, Centre of Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London, UK
- Dynamical Cell Systems Group, Division of Cancer Biology, Institute of Cancer Research, London, UK
- Cancer Research UK Convergence Science Centre, London, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Jethro Adam Herberg
- Section of Paediatric Infectious Disease, Imperial College London, London, UK
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Wen Y, Yang Y, Wen Y, Xi J, Chen T, Lu Y, Wang L, Liu Y, Si F. Ultrasound evaluation of endothelial dysfunction in immunoglobulin-resistant children with acute Kawasaki disease. Clin Rheumatol 2022; 41:3797-3805. [PMID: 35982351 DOI: 10.1007/s10067-022-06341-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/22/2022] [Accepted: 08/15/2022] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Given the evidence that brachial artery flow-mediated dilation (FMD) is declined in children later after the onset of Kawasaki disease (KD), we hypothesized that indicators that detect the situation of the endothelium are useful parameters that can accurately reflect subclinical dysfunction in resistant patients and assist in differentiating patients with KD at a higher risk of IVIG resistance, which may be valuable in better understanding how to protect patients from endothelial and thrombotic complications. METHODS Fifty IVIG-resistant KD children, 120 IVIG-responsive KD children, 35 febrile children with acute upper respiratory infection, and 50 healthy controls were recruited, and indicators reflecting endothelial inflammation, including flow-mediated dilation (FMD), were measured. Receiver operating characteristic (ROC) curve analysis was utilized to determine the threshold values of these indicators of IVIG resistance. Multiple logistic regression analysis was performed to determine whether FMD was an independent predictor of IVIG-resistant patients. RESULTS In comparison with the lab data, PCT, Na + , and FMD exhibited AUCs of 0.727, 0.653, and 0.698 (P < 0.05), respectively, in predicting IVIG resistance in KD through ROC analysis. PCT > 1.69 ng/ml, Na + < 133.2 mmol/l, and FMD < 5.79% were independent predictors of IVIG resistance in KD (OR 4.257, 3.516, 3.563, 95% CI 1.549 ~ 11.700, 1.277 ~ 9.680, 1.299 ~ 9.772, P < 0.05). CONCLUSION More severe endothelial dysfunction, especially lower FMD, was present in IVIG-resistant patients than in IVIG-responsive patients. It is a helpful diagnostic tool that provides supportive criteria to detect KD patients at a higher risk of IVIG resistance when FMD < 5.79% in children. Key Points • IVIG-resistant KD patients have more severe endothelial dysfunction than IVIG-sensitive patients. • FMD < 5.79% may indicate an increased risk of IVIG resistance in children with Kawasaki disease.
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Affiliation(s)
- Yizhou Wen
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China.
| | - Yanfeng Yang
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China.
| | - Yang Wen
- Ultrasonography Department, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Jimei Xi
- Ultrasonography Department, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Tingting Chen
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China
| | - Yaheng Lu
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China
| | - Li Wang
- Department of Clinical Laboratory, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yiling Liu
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China
| | - Feifei Si
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China
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Lee W, Cheah CS, Suhaini SA, Azidin AH, Khoo MS, Ismail NAS, Ali A. Clinical Manifestations and Laboratory Findings of Kawasaki Disease: Beyond the Classic Diagnostic Features. Medicina (B Aires) 2022; 58:medicina58060734. [PMID: 35743997 PMCID: PMC9227912 DOI: 10.3390/medicina58060734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
Kawasaki disease (KD) has shown a marked increase in trend over the globe, especially within the last two decades. Kawasaki disease is often seen in the paediatric population below five years old, while it is rare for those who are beyond that age. Up to this date, no exact causes has been identified although KD was found more than half a century ago. The underlying pathogenesis of the disease is still unelucidated, and researchers are trying to unlock the mystery of KD. To further complicate the diagnosis and the prompt management, a specific biomarker for the diagnosis of KD is yet to be discovered, making it hard to differentiate between KD and other diseases with a similar presentation. Nonetheless, since its discovery, clinicians and scientists alike had known more about the different clinical aspects of typical KD. Thus, this article intends to revisit and review the various clinical manifestations and laboratory characteristics of KD in order to guide the diagnosis of KD.
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Affiliation(s)
- Wendy Lee
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Chooi San Cheah
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Siti Aisyah Suhaini
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Abdullah Harith Azidin
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Mohammad Shukri Khoo
- Department of Pediatric, Hospital Wanita dan Kanak Kanak Sabah, Kota Kinabalu 88996, Malaysia;
| | - Noor Akmal Shareela Ismail
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia;
| | - Adli Ali
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
- Correspondence: ; Tel.: +603-91748510
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A new scoring system for coronary artery abnormalities in Kawasaki disease. Pediatr Res 2022; 92:275-283. [PMID: 34584222 PMCID: PMC8476714 DOI: 10.1038/s41390-021-01752-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/09/2021] [Accepted: 08/31/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND In China, coronary artery abnormalities (CAAs) secondary to Kawasaki disease (KD) tend to have an increased occurrence. We hypothesize that Chinese children with KD may possess several unique CAA risks, and the predictive efficacy of multiple scoring systems in Chinese patients are still to be further studied. METHODS Two hundred and three KD patients were recruited. Using multivariable analysis, independent predictors of CAAs were combined into a scoring system. Subsequently, CAA risks of our patients were evaluated by the newly established scoring system and eight other published scoring systems. RESULTS Seventeen (8.37%) KD patients were identified as CAAs. The newly established scoring system contained the following 5 independent predictors: days of illness at initial treatment ≥7, redness and swelling of extremities, hematocrit ≤33%, percentage of monocytes ≥8.89%, and procalcitonin ≥0.5 ng/mL. The AUC value of newly established scoring system was 0.685 with a sensitivity of 41.18% and a specificity of 84.41%, higher than Harada score, Egami score, Kobayashi score, Sato score, San Diego score, Formosa score, and Tang score, whereas lower than Hua score. CONCLUSIONS Days of illness at initial treatment ≥7 and procalcitonin are unique predictors of CAAs in newly established scoring system. Taking into account different identification criteria and analytical methodologies, there is still some heterogeneity among different scoring systems. IMPACT The newly established scoring system contains the five independent predictors. Days of illness at initial treatment ≥7 and PCT are unique predictors of CAAs in our study, compared with 8 other systems. The AUC value of newly established scoring system is 0.685, similar to Hua score. There is some heterogeneity among different scoring systems.
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Yang M, Pei Q, Zhang J, Weng H, Jing F, Yi Q. Association between adropin and coronary artery lesions in children with Kawasaki disease. Eur J Pediatr 2021; 180:2253-2259. [PMID: 33712900 DOI: 10.1007/s00431-021-03977-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 12/01/2022]
Abstract
Kawasaki disease (KD) is an acute systemic vasculitis in children. Coronary artery lesions (CALs) are the most serious complications in KD, but the pathogenesis is still unclear so far. Adropin, a new biopeptide, plays an important role in metabolism and cardiovascular function. The aim of this study was to explore the relationship between adropin and KD. 66 KD patients and 22 healthy controls (HCs) were included in the study. KD patients were divided into KD with coronary artery lesions (KD-CALs) group and KD without CALs (KD-NCALs) group. The levels of serum adropin were determined by enzyme-linked immunosorbent assay (ELISA). Compared with the HC group, adropin concentrations were significantly increased in the KD group (p < 0.05), and the KD-CAL group had higher levels of adropin than those in the KD-NCAL group (p < 0.05). Pct (Procalcitonin) and DD (D-dimer) were positively correlated with adropin in the KD group (p < 0.05). Moreover, adropin had positive correlations with CRP (C-reactive protein) and DD in the KD-NCAL group and positive correlations with Pct, PLR (platelet-to-lymphocyte ratio), and DD in the KD-CAL group (p < 0.05). The receiver operating characteristic (ROC) curve showed that the best threshold value of serum adropin level was more than 2.8 ng/mL, with 72.2% sensitivity and 71.4% specificity for predicting CALs in children with KD.Conclusion: Adropin might be involved in the pathogenesis of KD and CALs and can be used as an auxiliary diagnostic biomarker of KD. What is Known: • CALs in KD were mainly caused by inflammation, immune imbalance, and vascular endothelial dysfunction, and adropin is involved in metabolic diseases and cardiovascular diseases. What is New: • In this study, we have found the relationship between adropin and KD, and serum adropin level can be used as an auxiliary diagnostic biomarker to predict CALs in KD.
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Affiliation(s)
- Maoling Yang
- Department of Cardiovascular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Qiongfei Pei
- Department of Cardiovascular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Jing Zhang
- Department of Cardiovascular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Haobo Weng
- Department of Cardiovascular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Fengchuan Jing
- Department of Cardiovascular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Qijian Yi
- Department of Cardiovascular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China. .,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
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Clinical implications of procalcitonin in Kawasaki disease: a useful candidate for differentiating from sepsis and evaluating IVIG responsiveness. Clin Exp Med 2021; 21:633-643. [PMID: 33839960 PMCID: PMC8036161 DOI: 10.1007/s10238-021-00709-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/26/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Kawasaki disease (KD) is an acute systemic vasculitis and suspected to be triggered by several potential infections in which procalcitonin (PCT) experiences an increase to some extent. However, whether PCT can serve as a useful candidate for differentiating KD from sepsis, and even for predicting incomplete KD, intravenous immunoglobulin (IVIG) nonresponsiveness and coronary artery abnormalities (CAAs) remains unclear. METHODS A total of 254 Chinese KD children were enrolled and divided into 6 subgroups, including complete KD, incomplete KD, IVIG-responsive KD, IVIG-nonresponsive KD, KD with CAAs and KD without CAAs. Blood samples were collected from all subjects within 24-h pre- and 48-h post-IVIG infusion, respectively. PCT, C-reactive protein, erythrocyte sedimentation rate and blood cell counts were detected. In addition, both 261 children with sepsis and 251 healthy children sex- and age-matched with KD children were enrolled in the same period. RESULTS (1) PCT experienced the highest increase in sepsis patients before antibiotic therapy, followed by acute KD patients and the healthy controls. (2) The proportion of KD patients with a PCT concentration below 0.25 ng/ml was 11 folds higher than that of sepsis patients. (3) PCT had a sensitivity of 91.7% and a specificity of 30.3% at a cutoff value of > 0.15 ng/ml to predict IVIG nonresponsiveness, and the proportion of IVIG-nonresponders with a PCT concentration of 0.25-0.50 ng/ml was 2 folds higher than that of IVIG-responders. CONCLUSIONS The PCT concentrations below 0.25 ng/ml may be useful for discriminating KD from sepsis, and moreover, the PCT concentrations of 0.25-0.50 ng/ml may be helpful in predicting IVIG nonresponsiveness.
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Trachtman R, Murray E, Wang CM, Szymonifka J, Toussi SS, Walters H, Nellis ME, Onel KB, Mandl LA. Procalcitonin Differs in Children With Infection and Children With Disease Flares in Juvenile Idiopathic Arthritis. J Clin Rheumatol 2021; 27:87-91. [PMID: 31693652 PMCID: PMC10364140 DOI: 10.1097/rhu.0000000000001170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Patients with juvenile idiopathic arthritis (JIA) often present with signs and symptoms suggestive of serious bacterial infection (SBI). Procalcitonin (PCT) is a biomarker that is elevated in SBI. We conducted a comparative cohort study to test the hypothesis that PCT levels will differ between active JIA, quiescent JIA, and bacteremic patients and healthy controls. METHODS From October 2016 to May2018, consecutive children 6 months to 18 years of age with (a) active untreated JIA, (b) quiescent JIA, and (c) healthy elective presurgical candidates were recruited from clinics at a musculoskeletal specialty hospital. Juvenile idiopathic arthritis was defined according to the International League of Associations for Rheumatology criteria. Clinical data and serum samples meeting the same criteria were included from a prior study. Consecutive bacteremic patients were identified over the same period. Procalcitonin and other common measures of inflammation were measured. Descriptive statistics and univariate logistic analyses were performed. RESULTS Ninety-two study subjects were recruited. Erythrocyte sedimentation rate, C-reactive protein (CRP), and PCT levels were all elevated in bacteremic patients in comparison to the other groups. Erythrocyte sedimentation rate and CRP both had wide ranges that overlapped between groups; however, the PCT concentration was 0.15 μg/mL or greater in 1 of 59 patients with JIA, whereas it was 0.15 μg/mL or less in only 1 bacteremic patient. CONCLUSIONS Our study indicates that serum erythrocyte sedimentation rate, CRP, and PCT levels are all biomarkers that can be used to distinguish SBI versus active JIA at presentation. However, PCT is the most accurate, with the least overlap between patients with infection and noninfectious inflammatory arthritis. This finding can help clinicians direct therapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Karen B. Onel
- Hospital for Special Surgery
- Weill Cornell Medicine, New York
| | - Lisa A. Mandl
- Hospital for Special Surgery
- Northwell Health, Lake Success, NY
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Khanna S, Garikapati K, Goh DSL, Cho K, Lo P, Bhojaraja MV, Tarafdar S. Coronary artery vasculitis: a review of current literature. BMC Cardiovasc Disord 2021; 21:7. [PMID: 33407141 PMCID: PMC7788693 DOI: 10.1186/s12872-020-01813-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
Cardiac vasculitis is recognized as a heterogeneous disease process with a wide spectrum of manifestations including pericarditis, myocarditis, valvular heart disease and less frequently, coronary artery vasculitis (CAV). CAV encompasses an emerging field of diseases which differ from conventional atherosclerotic disease and have a proclivity for the younger population groups. CAV portends multiple complications including the development of coronary artery aneurysms, coronary stenotic lesions, and thrombosis, all which may result in acute coronary syndromes. There are several aetiologies for CAV; with Kawasaki's disease, Takayasu's arteritis, Polyarteritis Nodosa, and Giant-Cell Arteritis more frequently described clinically, and in literature. There is a growing role for multi-modality imaging in assisting the diagnostic process; including transthoracic echocardiography, cardiac magnetic resonance imaging, computed tomography coronary angiography, fluorodeoxyglucose-positron emission tomography and conventional coronary angiogram with intravascular ultrasound. Whilst the treatment paradigms fundamentally vary between different aetiologies, there are overlaps with pharmacological regimes in immunosuppressive agents and anti-platelet therapies. Interventional and surgical management are is a consideration in select populations groups, within a multi-disciplinary context. Further large-scale studies are required to better appropriately outline management protocols in this niche population.
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Affiliation(s)
- Shaun Khanna
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.
| | - Kartheek Garikapati
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Daniel S L Goh
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Kenneth Cho
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Phillip Lo
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | | | - Surjit Tarafdar
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.,Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia
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11
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Hu J, Ren W. Analysis of the Risk Factors in Prognosis of Kawasaki Disease With Coronary Artery Lesions. Front Pediatr 2021; 9:798148. [PMID: 34950620 PMCID: PMC8688820 DOI: 10.3389/fped.2021.798148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/19/2021] [Indexed: 12/19/2022] Open
Abstract
Kawasaki disease (KD) is one of the most common forms of systemic vasculitis in children. Pathological features include extensive inflammation of small and medium blood vessels throughout the body. The primary complication of KD is coronary artery lesions (CALs). A total of 640 children with KD were admitted to the Department of Pediatric Cardiology at Shengjing Hospital of China Medical University from January 2017 to December 2019. These patients comprised 52 coronary artery aneurysm (CAA) cases and 47 coronary artery dilation (CAD) cases. Echocardiography was performed during the acute KD phase and then at 1, 3, 6, 12, and 24 months after KD onset. Patients were divided into a poor prognosis group (n = 30) and a normal group (n = 69) based on CALs prognosis. Differences in laboratory data, clinical manifestations and coronary artery damage rates were compared between the two groups. Univariate analysis was performed on these data, and an ROC curve was used to analyze the efficacy of each risk factor. Univariate analysis revealed that age (months), number of coronary arteries involved (NACI), IgM, IgA and brain natriuretic peptide (ProBNP) levels were higher in the poor prognosis group compared with the normal group, procalcitonin (PCT) levels in the poor prognosis group were lower than in the normal group (P < 0.05). Conclusion: Age ≥ 18 months, IgM ≥ 1.07g/L, IgA ≥ 0.728g/L and NCAI ≥ 3 were poor prognostic factors of KD children with CALs. These parameters can be used as a reference indicator of early prediction where combined detection might improve the accuracy and sensitivity of prediction. Follow-up should be maintained to monitor changes in the coronary artery by echocardiography.
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Affiliation(s)
- Jinling Hu
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Shengjing Hospital of China Medical University, Shenyang, China
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Bavare A, Rissmiller B, Devaraj S, Guffey D, Rajapakshe D, Weiner H, Caldarone C, Shekerdemian L. Perioperative Procalcitonin in Predicting Infection in Children Undergoing Surgical Procedures. J Surg Res 2020; 258:332-338. [PMID: 33131765 DOI: 10.1016/j.jss.2020.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/04/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Procalcitonin (PCT) is a biomarker of bacterial infections with more sensitivity and specificity than commonly used inflammatory markers. PCT can be particularly helpful in the postsurgical population where the surgery itself often leads to noninfectious inflammation. We aimed to examine the utility of perioperative profiles of PCT in predicting infection in two pediatric surgical populations. METHODS We conducted a prospective observational study of perioperative PCT in children undergoing cardiac or neurosurgery. Consenting patients with no preoperative infection or immune deficiency were enrolled. We measured plasma PCT levels within 24 h preprocedure and 24-48 h postprocedure. Demographic, clinical, and laboratory data were collected from the medical records including clinical suspicion and confirmed infections. Perioperative PCT changes and their associations with these data are reported. RESULTS We enrolled 26 neuro and 15 cardiac surgery patients. There was postoperative clinical suspicion of infection in 3 neuro and 5 cardiac patients, and 1 neuro and 2 cardiac patients had subsequently confirmed infections. Cardiac patients had higher overall perioperative PCT increase than neuro cohort (P = 0.006). Neuro patient with infection had higher perioperative change in PCT (0.5 to 1.4 ng/mL) than noninfected neurosurgery patients. Cardiac patients with confirmed infections had higher postoperative levels which exceeded the previously described infection threshold of 2 ng/mL. CONCLUSIONS PCT is a useful early biomarker of postoperative infection in pediatric patients undergoing cardiac and neurosurgery. Patients who underwent cardiac surgery have significantly higher perioperative PCT rise than patients who underwent neurosurgery, and all patients with subsequently confirmed infections had at least 2-fold perioperative PCT increase.
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Affiliation(s)
- Aarti Bavare
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
| | - Brian Rissmiller
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Sridevi Devaraj
- Section of Chemistry, Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research, Section of Biostatistics, Baylor College of Medicine, Houston, Texas
| | - Deepthi Rajapakshe
- Section of Chemistry, Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Howard Weiner
- Section of Neurosurgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Christopher Caldarone
- Section of Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Lara Shekerdemian
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Procalcitonin as a Biomarker of Unresponsiveness to Intravenous Immunoglobulin for Kawasaki Disease. Pediatr Infect Dis J 2020; 39:857-861. [PMID: 32433223 DOI: 10.1097/inf.0000000000002716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the usefulness of procalcitonin (PCT) as predictive factors of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease patients. METHODS We retrospectively analyzed the laboratory data from 215 children with Kawasaki disease treated with IVIG from 2014 to 2019. We analyzed the clinical and laboratory parameters just before the IVIG including serum levels of PCT with respect to the IVIG response. RESULTS Eventually, 127 patients were analyzed. The median age was 2.4 years. IVIG was effective in 108 children (responders) and was ineffective in 19 (non-responders). Serum PCT concentration was higher in non-responders than those of responders (P < 0.001). Multivariate logistic regression analyses indicated that higher PCT concentration (odds ratio 1.34, 95% confidence interval 1.10-1.64) were associated with IVIG resistance. Analyses of the receiver operating characteristic curve showed that the cutoff value of PCT 2.18 ng/mL had 46.4% of sensitivity and 93.9% of specificity. Receiver operating characteristic analysis yielded an area under the curve of 0.82 (0.72-0.92) to predict IVIG resistance. CONCLUSIONS Serum PCT value can be an excellent biomarker for predicting unresponsiveness to IVIG with a good discriminatory ability as well as the existing prediction scores.
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Wang Y, Qian SY, Yuan Y, Wang Q, Gao L, Chen X, Yu X, Zhen Z. Do cytokines correlate with refractory Kawasaki disease in children? Clin Chim Acta 2020; 506:222-227. [PMID: 32156603 DOI: 10.1016/j.cca.2020.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Kawasaki disease (KD) is a type of pediatric vasculitis. Ten to twenty percent of children with KD do not respond to initial intravenous immunoglobulin (IVIG) treatment which called refractory Kawasaki disease. If untreated, approximately 15-25% of KD patients have complications. Therefore, it is important to predict whether KD is resistant to IVIG at an early stage. The aim of this study was to determine whether cytokines are predictors of refractory KD in children. METHODS We retrospectively reviewed the medical records of 265 children diagnosed with KD who received IVIG within 10 days of fever onset at Beijing Children's Hospital. Refractory Kawasaki disease was defined as persistent or recrudescent fever beyond 36 h after IVIG. Before IVIG and 3 days after temperature normalization following IVIG treatment, the concentrations of cytokines in the serum including interferon gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), interleukin-6 (IL-6), interleukin-4 (IL-4), interleukin-2 (IL-2) and other conventional inflammatory mediators including white blood cells counts (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and albumin were detected. The patients were divided into 2 groups: IVIG-sensitive group and refractory group. RESULTS Of the 265 patients, 47 (17.7%) were refractory. After treatment with IVIG, the serum levels of IFN-γ, TNF-α, IL-10 and IL-6 in both groups were significantly lower than those before treatment (P < 0.05). Before treatment, the serum levels of IFN-γ, TNF-α, IL-10 and IL-6 in refractory group were significantly higher than those in IVIG-sensitive group (P < 0.05). There were no significant differences in IL-4 or IL-2 levels between the 2 groups. The results of logistic regression analysis showed that IFN-γ, IL-6, fever duration and serum albumin were independent risk factors for refractory KD. The area under the receiver operating characteristic curve (ROC curve) for IFN-γ was 0.781, and the cut-off value for refractory was 7.37 pg/ml, while the area under the ROC curve for IL-6 was 0.837, and the cut-off value for refractory was 70.13 pg/ml. CONCLUSIONS IFN-γ and IL-6 were independent risk factors for refractory Kawasaki disease in children. KD patients with serum levels of IFN-γ above 7.37 pg/ml and IL-6 above 70.13 pg/ml before treatment were prone to refractory.
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Affiliation(s)
- Ying Wang
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Su Yun Qian
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yue Yuan
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Qin Wang
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Lu Gao
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xi Chen
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xia Yu
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Zhen Zhen
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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15
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Shao S, Luo C, Zhou K, Hua Y, Wu M, Liu L, Liu X, Wang C. Predictive value of serum procalcitonin for both initial and repeated immunoglobulin resistance in Kawasaki disease: a prospective cohort study. Pediatr Rheumatol Online J 2019; 17:78. [PMID: 31775782 PMCID: PMC6882026 DOI: 10.1186/s12969-019-0379-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/06/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intravenous immunoglobulin (IVIG) resistance prediction is one pivotal topic of interests in Kawasaki disease (KD) since those patients with KD resistant to IVIG might improve of an early-intensified therapy. Data regarding predictive value of procalcitonin (PCT) for IVIG resistance, particularly for repeated IVIG resistance in KD was limited. This study aimed to testify the predictive validity of PCT for both initial and repeated IVIG resistance in KD. METHODS A total of 530 KD patients were prospectively recruited between January 2015 and March 2019. The clinical and laboratory data were compared between IVIG-responsive and IVIG-resistant groups. Multivariate logistic regression analysis was applied to determine the association between PCT and IVIG resistance. Receiver operating characteristic (ROC) curves analysis was further performed to assess the validity of PCT in predicting both initial and repeated IVIG resistance. RESULTS The serum PCT level was significantly higher in initial IVIG-resistance group compared with IVIG-response group (p = 0.009), as well as between repeated IVIG responders and nonresponders (p = 0.017). The best PCT cutoff value for initial and repeated IVIG resistance prediction was 1.48 ng/ml and 2.88 ng/ml, respectively. The corresponding sensitivity was 53.9 and 51.4%, while the specificity were 71.8 and 73.2%, respectively. Multivariate logistic regression analysis failed to identify serum PCT level as an independent predictive factor for both initial and repeated IVIG resistance in KD. CONCLUSIONS Serum PCT levels were significantly higher in IVIG nonresponders, but PCT may not be suitable as a single marker to accurately predict both initial and repeated IVIG resistance in KD.
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Affiliation(s)
- Shuran Shao
- 0000 0004 1757 9397grid.461863.eDepartment of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38West China Medical School of Sichuan University, Chengdu, Sichuan China
| | - Chunyan Luo
- 0000 0004 1770 1022grid.412901.fDepartment of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Kaiyu Zhou
- 0000 0004 1757 9397grid.461863.eDepartment of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan China ,0000 0004 1757 9397grid.461863.eThe Cardiac development and early intervention unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,0000 0004 0369 313Xgrid.419897.aKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Chengdu, Sichuan China ,0000 0004 1757 9397grid.461863.eKey Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Yimin Hua
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, China. .,The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Chengdu, Sichuan, China. .,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Mei Wu
- 0000 0004 1757 9397grid.461863.eDepartment of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38West China Medical School of Sichuan University, Chengdu, Sichuan China
| | - Lei Liu
- 0000 0004 1757 9397grid.461863.eDepartment of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38West China Medical School of Sichuan University, Chengdu, Sichuan China
| | - Xiaoliang Liu
- 0000 0004 1757 9397grid.461863.eDepartment of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan China ,0000 0004 0369 313Xgrid.419897.aKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Chengdu, Sichuan China ,0000 0004 1757 9397grid.461863.eKey Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, China. .,The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Chengdu, Sichuan, China. .,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
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Jindal AK, Pilania RK, Prithvi A, Guleria S, Singh S. Kawasaki disease: characteristics, diagnosis, and unusual presentations. Expert Rev Clin Immunol 2019; 15:1089-1104. [PMID: 31456443 DOI: 10.1080/1744666x.2019.1659726] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Kawasaki disease (KD) is one of the commonest pediatric vasculitides and is associated with a significant risk of development of coronary artery abnormalities if left untreated. Areas covered: In this review, we have highlighted the incomplete and unusual presentations of KD and also emphasize the controversies pertaining to 2D echocardiography in KD. A PubMed search was performed regarding diagnosis and unusual presentations of KD. Expert opinion: Diagnosis of KD is essentially clinical and based on recognition of typical clinical features that may appear sequentially and all signs and symptoms may not be present at one point of time. There is no confirmatory laboratory test for diagnosis of this condition. Further complicating the picture is the fact that incomplete and atypical forms KD may be seen in up to 50% patients. Although 2D echocardiography continues to be the preferred imaging modality for cardiac assessment in patients with KD, it has its limitations.
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Affiliation(s)
- Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Ashwini Prithvi
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Sandesh Guleria
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
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18
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Procalcitonin levels predicting the infliximab response of immunoglobulin resistant Kawasaki disease. Cytokine 2019; 114:26-31. [DOI: 10.1016/j.cyto.2018.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/30/2018] [Accepted: 11/25/2018] [Indexed: 12/24/2022]
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Chaudhary H, Nameirakpam J, Kumrah R, Pandiarajan V, Suri D, Rawat A, Singh S. Biomarkers for Kawasaki Disease: Clinical Utility and the Challenges Ahead. Front Pediatr 2019; 7:242. [PMID: 31275907 PMCID: PMC6591436 DOI: 10.3389/fped.2019.00242] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/28/2019] [Indexed: 12/11/2022] Open
Abstract
Kawasaki disease (KD) has replaced acute rheumatic fever as the most common cause of acquired heart disease in children in the developed world and is increasingly being recognized from several developing countries. It is a systemic vasculitis with a predilection for coronary arteries. The diagnosis is based on a constellation of clinical findings that appear in a temporal sequence. Quite understandably, this can become a problem in situations wherein the clinical features are not typical. In such situations, it can be very difficult, if not impossible, to arrive at a diagnosis. Several biomarkers have been recognized in children with acute KD but none of these has reasonably high sensitivity and specificity in predicting the course of the illness. A line up of inflammatory, proteomic, gene expression and micro-RNA based biomarkers has been studied in association with KD. The commonly used inflammatory markers e.g. erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and total leucocyte counts (TLC) lack specificity for KD. Proteomic studies are based on the identification of specific proteins in serum, plasma and urine by gel electrophoresis. A host of genetic studies have identified genes associated with KD and some of these genes can predict the course and coronary outcomes in the affected individuals. Most of these tests are in the early stages of their development and some of these can predict the course, propensity to develop coronary artery sequelae, intravenous immunoglobulin (IVIg) resistance and the severity of the illness in a patient. Development of clinical criteria based on these tests will improve our diagnostic acumen and aid in early identification and prevention of cardiovascular complications.
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Affiliation(s)
- Himanshi Chaudhary
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Johnson Nameirakpam
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajni Kumrah
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vignesh Pandiarajan
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Suri
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Serum Procalcitonin and Presepsin Levels in Patients with Generalized Pustular Psoriasis. DISEASE MARKERS 2018; 2018:9758473. [PMID: 30647802 PMCID: PMC6311837 DOI: 10.1155/2018/9758473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/24/2018] [Accepted: 10/31/2018] [Indexed: 01/15/2023]
Abstract
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.
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Fabi M, Corinaldesi E, Pierantoni L, Mazzoni E, Landini C, Bigucci B, Ancora G, Malaigia L, Bodnar T, Di Fazzio G, Lami F, Valletta E, Cicero C, Biasucci G, Iughetti L, Marchetti F, Sogno Valin P, Amarri S, Brusa S, Sprocati M, Maggiore G, Dormi A, Lanzoni P, Donti A, Lanari M. Gastrointestinal presentation of Kawasaki disease: A red flag for severe disease? PLoS One 2018; 13:e0202658. [PMID: 30180185 PMCID: PMC6122791 DOI: 10.1371/journal.pone.0202658] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 08/07/2018] [Indexed: 12/22/2022] Open
Abstract
Background Kawasaki 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. Objective To evaluate whether presenting abdominal manifestations identify a group at major risk for Intravenous immunoglobulin (IVIG)-resistance and coronary lesions. Methods Retrospective 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. Results 302 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). Conclusions This 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 registration 8/20014/O/OssN.
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Affiliation(s)
- Marianna Fabi
- Pediatric Cardiology and Adult Congenital Unit, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- * E-mail:
| | | | - Luca Pierantoni
- Department of Pediatrics, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Elisa Mazzoni
- Department of Pediatrics, Maggiore Hospital, Bologna, Italy
| | - Chiara Landini
- Department of Pediatrics, Maggiore Hospital, Bologna, Italy
| | | | - Gina Ancora
- Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Laura Malaigia
- Department of Pediatrics, Bufalini Hospital, Cesena, Italy
| | - Tetyana Bodnar
- Department of Pediatrics, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Giorgia Di Fazzio
- Department of Pediatrics, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Francesca Lami
- Department of Pediatric, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Valletta
- Department of Pediatrics, G.B.Morgagni–L. Pierantoni Hospital, AUSL della Romagna, Forlì, Italy
| | - Cristina Cicero
- Department of Pediatrics, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy
| | - Giacomo Biasucci
- Department of Pediatrics, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy
| | - Lorenzo Iughetti
- Department of Pediatric, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Federico Marchetti
- Department of Pediatrics, Santa Maria delle Croci Hospital, AUSL della Romagna, Ravenna, Italy
| | - Paola Sogno Valin
- Department of Pediatrics, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Sergio Amarri
- Department of Pediatrics, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Sandra Brusa
- Department of Pediatrics, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Monica Sprocati
- Department of Pediatrics, Arcispedale Sant’Anna, Ferrara, Italy
| | | | - Ada Dormi
- Department of Medical and Surgical Sciences DIMEC, University of Bologna, Bologna, Italy
| | - Paolo Lanzoni
- Department of Pediatrics, Ramazzini Hospital, Carpi, Italy
| | - Andrea Donti
- Pediatric Cardiology and Adult Congenital Unit, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Marcello Lanari
- Department of Pediatrics, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
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Hu P, Jiang GM, Wu Y, Huang BY, Liu SY, Zhang DD, Xu Y, Wu YF, Xia X, Wei W, Hu B. TNF-α is superior to conventional inflammatory mediators in forecasting IVIG nonresponse and coronary arteritis in Chinese children with Kawasaki disease. Clin Chim Acta 2017; 471:76-80. [PMID: 28526535 DOI: 10.1016/j.cca.2017.05.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/03/2017] [Accepted: 05/15/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Tumor necrosis factor (TNF) -α is of inflammatory cytokines produced chiefly by activated monocyte/macrophages, and has been implicated in the pathogenesis of Kawasaki disease (KD). We elucidated the relationship of plasma TNF-α with conventional inflammatory mediators, clinical classification, intravenous immunoglobulin (IVIG) response and coronary arteritis in the course of KD. METHODS Seventy Chinese children with KD were enrolled and divided into 6 subgroups, including complete KD, incomplete KD, IVIG-responsive KD, IVIG-nonresponsive KD, coronary artery (CA) -noninvolvement KD and CA-involvement KD. Blood samples were collected from all subjects at 24h pre- and 48h post-IVIG therapy, respectively. TNF-α, white blood cells counts (WBC), absolute neutrophil counts (ANC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and procalcitonin (PCT) were detected. RESULTS Plasma TNF-α markedly increased in the acute phase of KD and was positively correlated with CRP and PCT, whereas remained high after IVIG therapy. TNF-α as well as conventional inflammatory mediators could not be used to differentiate the clinical classification of KD, but they may prove beneficial to heighten or reduce the suspicion of incomplete KD. Plasma TNF-α was significantly higher in both IVIG-nonresponsive patients and coronary arteritis patients, but no significant differences were observed in all the other inflammatory mediators. Moreover, plasma TNF-α was positively correlated with the internal diameter of CA. CONCLUSIONS TNF-α is superior to conventional inflammatory mediators in forecasting IVIG nonresponse and coronary arteritis in Chinese children with KD.
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Affiliation(s)
- Peng Hu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei 230022, PR China.
| | - Guang Mei Jiang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei 230022, PR China
| | - Yue Wu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei 230022, PR China
| | - Bao Yu Huang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei 230022, PR China
| | - Si Yan Liu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei 230022, PR China
| | - Dong Dong Zhang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei 230022, PR China
| | - Yao Xu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei 230022, PR China
| | - Yang Fang Wu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei 230022, PR China
| | - Xun Xia
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei 230022, PR China
| | - Wei Wei
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei 230022, PR China
| | - Bo Hu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei 230022, PR China
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