Comparison laboratory data between children with Kawasaki Disease and COVID-19

Abstract Background: The 2019 coronavirus disease (COVID-19) has been an emerging, rapidly evolving situation in China since late 2019 and has even become a worldwide pandemic. The first case of severe childhood novel coronavirus pneumonia in China was reported in March 2020 in Wuhan. The severity differs between adults and children, with lower death rates and decreased severity for individuals under the age of 20 years old. Increased cases of Kawasaki disease (KD) have been reported from New York City and some areas of Italy and the U.K., with almost a 6-10 times increase when compared with previous years. We conducted this article to compare characters and laboratory data between KD and COVID-19 in children. Methods: We obtained a total of 24 COVID-19 children from the literature review and 234 KD cases from our hospital via retrospective chart review. Results: We found that patients with KD had higher levels of white blood cell (WBC), platelet, neutrophil percentage, C-reactive protein (CRP), procalcitonin, Aspartate Aminotransferase (AST), and body temperature, while patients with COVID-19 had higher age, hemoglobin levels, and lymphocyte percentage. After performing multiple logistic regression analysis, we found that age, WBC, platelet, procalcitonin, and AST provide identical markers for distinguishing COVID-19 from KD in children. Conclusion: In this COVID-19 pandemic period, clinicians should pay attention to children with COVID-19 infection when high WBC, platelet, procalcitonin, and AST values are present in order to provide precision treatment with intravenous immunoglobulin (IVIG) for KD or multisystem inflammatory syndrome in children (MIS-C).

Download Full-text

Comparison laboratory data between children with Kawasaki Disease and COVID-19

10.21203/rs.3.rs-266709/v2 ◽

2021 ◽

Author(s):

Yishuang Huang ◽

Ying-Hsien Huang ◽

Yuh-Chyn Tsai ◽

Shih-Feng Liu ◽

Ho-Chang Kuo

Keyword(s):

New York ◽

Kawasaki Disease ◽

Multiple Logistic Regression Analysis ◽

Laboratory Data ◽

Retrospective Chart Review ◽

Reactive Protein ◽

First Case ◽

Neutrophil Percentage ◽

Adults And Children ◽

Novel Coronavirus

Abstract Background:　 The 2019 coronavirus disease (COVID-19) has been an emerging, rapidly evolving situation in China since late 2019 and has even become a worldwide pandemic. The first case of severe childhood novel coronavirus pneumonia in China was reported in March 2020 in Wuhan. The severity differs between adults and children, with lower death rates and decreased severity for individuals under the age of 20 years old. Increased cases of Kawasaki disease (KD) have been reported from New York City and some areas of Italy and the U.K., with almost a 6-10 times increase when compared with previous years. We conducted this article to compare characters and laboratory data between KD and COVID-19 in children. Methods: We obtained a total of 24 COVID-19 children from the literature review and 234 KD cases from our hospital via retrospective chart review. Results: We found that patients with KD had higher levels of white blood cell (WBC), platelet, neutrophil percentage, C-reactive protein (CRP), procalcitonin, Aspartate Aminotransferase (AST), and body temperature, while patients with COVID-19 had higher age, hemoglobin levels, and lymphocyte percentage. After performing multiple logistic regression analysis, we found that age, WBC, platelet, procalcitonin, and AST provide identical markers for distinguishing COVID-19 from KD in children. Conclusion: In this COVID-19 pandemic period, clinicians should pay attention to children with COVID-19 infection when high WBC, platelet, procalcitonin, and AST values are present in order to provide precision treatment with intravenous immunoglobulin (IVIG) for KD or multisystem inflammatory syndrome in children (MIS-C).

Download Full-text

Prediction of repeated intravenous immunoglobulin resistance in children with Kawasaki disease

BMC Pediatrics ◽

10.1186/s12887-021-02876-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yaheng Lu ◽

Tingting Chen ◽

Yizhou Wen ◽

Feifei Si ◽

Xindan Wu ◽

...

Keyword(s):

Kawasaki Disease ◽

Intravenous Immunoglobulin ◽

Multiple Logistic Regression Analysis ◽

Laboratory Data ◽

Ivig Treatment ◽

Roc Curve Analysis ◽

Reactive Protein ◽

Ivig Resistance ◽

Intravenous Immunoglobulin Resistance ◽

Resistant Group

Abstract Background Repeated intravenous immunoglobulin (IVIG) resistance prediction is one of the pivotal topics in Kawasaki disease (KD). Those non-responders of repeated IVIG treatment might be improved by an early-intensified therapy to reduce coronary artery lesion and medical costs. This study investigated predictors of resistance to repeated IVIG treatment in KD. Methods A total of 94 children with IVIG-resistant KD treated at our hospital between January 2016 and August 2020 were retrospectively analyzed. According to the therapeutic effect of a second dose IVIG treatment, the children were divided into repeated IVIG-responsive group and repeated IVIG-resistant group, and the clinical and laboratory data were compared. Predictors of repeated IVIG resistance and the optimal cut-off value were determined by multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Results The Pre-IVIG laboratory data showed the percentage of neutrophils (N%) and levels of serum procalcitonin (PCT), N-terminal pro-brain natriuretic peptide (NT-proBNP) were significantly higher in repeated IVIG-resistant group compared with repeated IVIG-responsive group, while levels of serum sodium and albumin (ALB) were significantly lower (P < 0.05). The post-IVIG laboratory values of N% and C-reactive protein (CRP) were significantly higher in the repeated IVIG-resistant group compared with repeated IVIG-responsive group, while hemoglobin and ALB were lower (P < 0.05). Pre-IVIG PCT and post-IVIG CRP exhibited AUC of 0.751 and 0.778 respectively in predicting repeated IVIG resistance in KD. Pre-IVIG PCT > 1.81ng/ml (OR 4.1, 95 % CI 1.4 ~ 12.0, P < 0.05) and post-IVIG CRP > 45 mg/L (OR 4.6, 95 % CI 1.3 ~ 16.2, P < 0.05) were independent predictors of repeated IVIG resistance in KD. Conclusions Our study illustrates the serum PCT level before initial IVIG treatment and CRP after initial IVIG could be used to predict repeated IVIG resistance in KD.

Download Full-text

Clinical and Laboratory Profiles of 75 Hospitalized Patients with Novel Coronavirus Disease 2019 in Hefei, China

10.1101/2020.03.01.20029785 ◽

2020 ◽

Cited By ~ 12

Author(s):

Zonghao Zhao ◽

Jiajia Xie ◽

Ming Yin ◽

Yun Yang ◽

Hongliang He ◽

...

Keyword(s):

T Cell ◽

Treatment Effectiveness ◽

Antiviral Treatment ◽

Laboratory Data ◽

Clinical Manifestations ◽

Nasopharyngeal Swab ◽

The Novel ◽

Reactive Protein ◽

Cell Counts ◽

Novel Coronavirus

AbstractThe outbreak of the novel coronavirus disease 2019 (COVID-19) infection began in December 2019 in Wuhan, and rapidly spread to many provinces in China. The number of cases has increased markedly in Anhui, but information on the clinical characteristics of patients is limited. We reported 75 patients with COVID-19 in the First Affiliated Hospital of USTC from Jan 21 to Feb 16, 2020, Hefei, Anhui Province, China. COVID-19 infection was confirmed by real-time RT-PCR of respiratory nasopharyngeal swab samples. Epidemiological, clinical and laboratory data were collected and analyzed. Of the 75 patients with COVID-19, 61 (81.33%) had a direct or indirect exposure history to Wuhan. Common symptoms at onset included fever (66 [88.0%] of 75 patients) and dry cough (62 [82.67%]). Of the patients without fever, cough could be the only or primary symptom. The most prominent laboratory abnormalities were lymphopenia, decreased percentage of lymphocytes (LYM%), decreased CD4+ and CD8+ T cell counts, elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH). Patients with elevated interleukin 6 (IL-6) showed significant decreases in the LYM%, CD4+ and CD8+ T cell counts. Besides, the percentage of neutrophils, CRP, LDH and Procalcitonin levels increased significantly. We concluded that COVID-19 could cause different degrees of hematological abnormalities and damage of internal organs. Hematological profiles including LYM, LDH, CRP and IL-6 could be indicators of diseases severity and evaluation of treatment effectiveness. Antiviral treatment requires a comprehensive and supportive approach. Further targeted therapy should be determined based on individual clinical manifestations and laboratory indicators.

Download Full-text

Evolution of CT patterns in novel coronavirus (2019-nCoV) pneumonia in relation to clinical and laboratory data

Diagnostic radiology and radiotherapy ◽

10.22328/2079-5343-2021-12-2-49-58 ◽

2021 ◽

Vol 12 (2) ◽

pp. 49-58

Author(s):

А. А. Oganesyan ◽

I. V. Shrainer ◽

V. N. Vinogradov ◽

E. S. Pershina ◽

E. G. Koshelev ◽

...

Keyword(s):

Prognostic Value ◽

Patient Management ◽

Dynamic Change ◽

Laboratory Data ◽

Good Prognosis ◽

Organizing Pneumonia ◽

C Reactive Protein ◽

Reactive Protein ◽

Novel Coronavirus ◽

Ct Studies

Introduction. The CT patterns of coronavirus pneumonia are clear and represent certain pathomorphosis at the period of coronavirus pandemic. However, there are a lot of questions about influence of CT-patterns and their dynamic change on a disease’s severity. The aim of the study. To evaluate the dynamics of pulmonary CT changes of novel coronavirus (2019-nCoV) pneumonia in relation to clinical and laboratory data. Materials and methods. CT studies in dynamics of 108 patients with a of novel coronavirus (2019-nCoV) pneumonia were analyzed. The first CT study was performed on admission (6,7±4,1 days of the disease), the first control CT on 11,1±4,9 days of the disease, and the second CT control was performed on 16,7±5,6 days of the disease. Results. The volume of the lesion and the predominant CT symptom at admission did not affect the prognosis. However, changes in the repeated CT study had a high prognostic value. Thus, the occurrence of a pattern of organizing pneumonia during repeated study is associated with a good prognosis, while an increase in the zones of «crazy paving» and a larger volume of damage are unfavorable prognostic signs. An increase in the volume of changes in the type of ground glass and «crazy paving» correlated with increased levels of C-reactive protein, lactate dehydrogenase, and lymphopenia. Conclusion. Data from CT studies in dynamics for novel coronavirus (2019-nCoV) pneumonia have a prognostic value and, in combination with clinical and laboratory data, can influence decision-making on patient management.

Download Full-text

Can AI Help Pediatricians? Diagnosing Kawasaki Disease Using DRSA

Children ◽

10.3390/children8100929 ◽

2021 ◽

Vol 8 (10) ◽

pp. 929

Author(s):

Bartosz Siewert ◽

Jerzy Błaszczyński ◽

Ewelina Gowin ◽

Roman Słowiński ◽

Jacek Wysocki

Keyword(s):

Kawasaki Disease ◽

General Condition ◽

Early Stage ◽

Laboratory Data ◽

Decision Rules ◽

Final Diagnosis ◽

International Classification Of Diseases ◽

Reactive Protein ◽

Classification Of Diseases ◽

Icd 10

The DRSA method (dominance-based rough set approach) was used to create decision-making rules based on the results of physical examination and additional laboratory tests in the differential diagnosis of Kawasaki disease (KD), infectious mononucleosis and S. pyogenes pharyngitis in children. The study was conducted retrospectively. The search was based on the ICD-10 (International Classification of Diseases) codes of final diagnosis. Demographic and laboratory data from one Polish hospital (Poznan) were collected. Traditional statistical methods and the DRSA method were applied in data analysis. The algorithm formed 45 decision rules recognizing KD. The rules with the highest sensitivity (number of false negatives equals zero) were based on the presence of conjunctivitis and CRP (C-reactive Protein) ≥ 40.1 mg/L, thrombocytosis and ESR (Erythrocyte Sedimentation Rate) ≥ 77 mm/h; fair general condition and fever ≥ 5 days and rash; fair general condition and fever ≥ 5 days and conjunctivitis; fever ≥ 5 days and rash and CRP ≥ 7.05 mg/L. The DRSA analysis may be helpful in diagnosing KD at an early stage of the disease. It can be used even with a small amount of clinical or laboratory data.

Download Full-text

Age-Related Differences in the Association between Plasma High-Sensitivity C-Reactive Protein and Noncalcified or Mixed Coronary Atherosclerotic Plaques

Mediators of Inflammation ◽

10.1155/2020/5938957 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Tiewei Li ◽

Ning Chen ◽

Zhengan Liu ◽

Zhiming Shan ◽

Geng Dong ◽

...

Keyword(s):

Older Adults ◽

Multiple Logistic Regression Analysis ◽

Laboratory Data ◽

High Sensitivity ◽

Coronary Plaque ◽

Control Group ◽

C Reactive Protein ◽

Old Adults ◽

Reactive Protein ◽

Age Related

Background. Previous studies have demonstrated that plasma high-sensitivity C-reactive protein (hsCRP) was the predictor for unstable coronary plaque. Patients with noncalcified plaque (NCP) or mixed plaque (MP) have a higher risk of poor outcomes. However, the association between hsCRP and the presence of NCP or MP (NCP/MP) in old adults remains unclear, and if present, whether there exist differences between young and old adults remain unknown. Thus, the aim of this study was to investigate the role of hsCRP in predicting the presence of NCP/MP and evaluate whether age has any impact on this association. Methods. A total of 951 subjects were included in this study. Complete clinical and laboratory data were collected. According to the characteristics of the most stenotic plaque, we divided them into 2 groups: calcified plaque (CP) and NCP/MP. Subjects with no plaque were classified as the control group (CR). Subjects with age≥60 years were defined as older adults, and those with age<60 years were classified as nonelderly people. Results. Patients with NCP/MP had significantly higher hsCRP level compared with subjects with CR or CP in older adults but not in nonelderly people. The proportion of NCP/MP was significantly increased from 27.0% in the hsCRP<1.25 mg/L group to 42.7% in the hsCRP>2.70 mg/L group in older adults. Multiple logistic regression analysis showed that hsCRP was an independent risk factor for the presence of NCP/MP (odds ratio OR=1.093, 95% CI 1.032–1.157, P=0.001) only in older adults. Conclusions. hsCRP is independently associated with the presence of NCP/MP in older adults but not in nonelderly people. These results suggest the potential significance of hsCRP-lowering regimens in older adults with NCP/MP.

Download Full-text

Prediction of Repeated Intravenous Immunoglobulin Resistance in Children With Kawasaki Disease

10.21203/rs.3.rs-465858/v1 ◽

2021 ◽

Author(s):

Yaheng Lu ◽

Tingting Chen ◽

Yizhou Wen ◽

Feifei Si ◽

Xindan Wu ◽

...

Keyword(s):

Kawasaki Disease ◽

Intravenous Immunoglobulin ◽

Multiple Logistic Regression Analysis ◽

Laboratory Data ◽

Ivig Treatment ◽

Roc Curve Analysis ◽

Ivig Resistance ◽

Intravenous Immunoglobulin Resistance ◽

Resistant Group ◽

Resistance Prediction

Abstract Background: Repeated intravenous immunoglobulin (IVIG) resistance prediction is one of the pivotal topics in Kawasaki disease (KD). Those non-responders of repeated IVIG treatment might be improved by an early-intensified therapy to reduce coronary artery lesion and medical costs. This study investigated predictors of resistance to repeated IVIG treatment in KD.Methods: A total of 94 children with IVIG-resistant KD treated at our hospital between January 2016 and August 2020 were retrospectively analyzed. According to the therapeutic effect of a second dose IVIG treatment, the children were divided into repeated IVIG-responsive group and repeated IVIG-resistant group, and the clinical and laboratory data were compared. Predictors of repeated IVIG resistance and the optimal cut-off value were determined by multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis.Results: The laboratory data of the percentage of neutrophils (N%) and levels of serum procalcitonin (PCT), N-terminal pro-brain natriuretic peptide (NT-proBNP) on admission were significantly higher in repeated IVIG-resistant group compared with repeated IVIG-responsive group, while levels of serum sodium (Na+) and albumin (ALB) were significantly lower (P<0.05). The clinic data showed no significant differences between the two groups. PCT exhibited the largest AUC (0.751) in predicting repeated IVIG resistance in KD compared with N%, Na+, ALB, and NT-proBNP. PCT>1.81ng/ml was an independent predictor of repeated IVIG resistance in KD (OR 4.161, 95% CI 1.441~12.017, P=0.008). Conclusions: Our study illustrates the serum PCT level before initial IVIG treatment could be used to predict repeated IVIG resistance in KD.

Download Full-text

Multisystem Inflammatory Syndrome with Features of Atypical Kawasaki Disease during the COVID-19 Pandemic

Case Reports in Pediatrics ◽

10.1155/2021/9950588 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Reza Shahriarirad ◽

Anahita Sanaei Dashti ◽

Shabnam Hajiani Ghotbabadi

Keyword(s):

Kawasaki Disease ◽

Systemic Vasculitis ◽

Organ Damage ◽

Laboratory Evaluation ◽

Number Of Children ◽

Reactive Protein ◽

Public Crisis ◽

Exact Etiology ◽

Novel Coronavirus ◽

Inflammatory Syndrome

Background. Although Kawasaki disease (KD) is the most common self-limited systemic vasculitis in pediatrics, the exact etiology of the disease, its association with other diseases, and pathogens is still unknown. In order to achieve a better understanding and management of the disease, documentation and reporting of atypical cases is justified, particularly with the growing number of children with inflammatory syndrome with clinical features simulating KD during the COVID-19 pandemic. Here, we present a case of an atypical case of KD presenting as multisystem inflammatory syndrome (MIS) during the COVID-19 pandemic. Case Presentation. The patient is a 7-year-old girl who developed fever (39°C) and erythematous multiform rash on the abdomen and along with erythema and edema on the extremities. Laboratory evaluation revealed neutrophilia and lymphopenia along with elevated C-reactive protein, erythrocyte sedimentation rate, troponin, lactate dehydrogenase, ferritin, and D-dimer. Although the patient did not fulfill the KD criteria, based on approved guidelines and approaches regarding atypical KD and multisystem inflammatory syndrome in children (MIS-C) during the COVID-19 pandemic, intravenous immunoglobulin along with aspirin was administered for the patients. The patient’s symptoms resolved with an uneventful postdischarge course. Conclusion. Early diagnosis and treatment of patients meeting full or partial criteria for KD are critical to preventing end-organ damage and other long-term complications, especially during times of public crisis and global health emergencies, such as the novel coronavirus pandemic.

Download Full-text

Utility of Ferritin, Procalcitonin, and C-reactive Protein in Severe Patients with 2019 Novel Coronavirus Disease

10.21203/rs.3.rs-18079/v1 ◽

2020 ◽

Cited By ~ 10

Author(s):

Bo Zhou ◽

Jianqing She ◽

Yadan Wang ◽

Xiancang Ma

Keyword(s):

Ferritin Level ◽

Serum Levels ◽

Clinical Prognosis ◽

Medical College ◽

Reactive Protein ◽

Neutrophil Percentage ◽

Union Hospital ◽

Severe Group ◽

Novel Coronavirus ◽

Poor Clinical Prognosis

Abstract Objectives It is of clinical significance to evaluate the disease severity and investigate possible biomarkers of 2019 Novel coronavirus disease (COVID-19). In this study, we aim to describe the clinical characteristics of infection makers in severe and very severe patients with COVID-19. Methods This is a single center, observational analysis. We enrolled 48 in-hospital severe patients with COVID-19 admitted to the West District of Union Hospital of Tongji Medical College and analyzed infection biomarkers in 20 patients who had been tested for ferritin, PCT, CRP, etc. Results The median age was 59yrd (inter quartile range [IQR]:46-61) among severe COVID-19 group and 57yrd (IQR:45-71.5) among very severe group. We noted significantly increased CRP (1.48mg/L [IQR: 16.69-2.74] vs. 57.98mg/L [IQR: 38.335-77.565], P<0.05), PCT(0.05ng/ml [IQR: 0.03-0.06] vs. 0.21ng/ml [IQR: 0.11-0.42], P<0.05) and ferritin (291.13ng/ml [IQR: 102.1-648.42] vs. 1006.16ng/ml [IQR: 408.265-1988.25]). For blood count, significant increase was noticed in neutrophil percentage (67.6% [IQR: 61.8-76.4] vs. 86.7% [IQR: 82-92.35], P<0.01) and neutrophil count (3.75*10^9/L [IQR: 3.42-4.93] vs. 8.11*10^9/L [IQR: 5.675-8.905], P<0.05); and decrease was seen in lymphocyte percentage (22.7% [IQR: 17.4-27.4] vs. 8% [IQR: 4.85-13], P<0.05), lymphocyte count (1.62*10^9/L [IQR: 0.7-1.73] vs. 0.68*10^9/L [IQR: 0.385-1.04], P<0.05), and platelet count (214*10^9/L [IQR: 184-247] vs. 147*10^9/L [IQR: 126-202.5], P<0.05). Conclusions The serum levels of CRP, PCT and ferritin are markedly increased in very severe compared with severe COVID-19. Increased CRP, PCT and ferritin level might correlate to secondary bacterial infection and associated with poor clinical prognosis.

Download Full-text

Characteristics and risk factors associated with critical illness in pediatric COVID-19

Annals of Intensive Care ◽

10.1186/s13613-020-00790-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Grace Fisler ◽

◽

Stephanie M. Izard ◽

Sareen Shah ◽

Deirdre Lewis ◽

...

Keyword(s):

New York ◽

Critical Illness ◽

Organ Dysfunction ◽

Pediatric Patients ◽

Retrospective Chart Review ◽

Hemodynamic Instability ◽

Acute Chest Syndrome ◽

Factors Associated ◽

Reactive Protein ◽

Pediatric Hospitals

Abstract Background While much has been reported regarding the clinical course of COVID-19 in children, little is known regarding factors associated with organ dysfunction in pediatric COVID-19. We describe critical illness in pediatric patients with active COVID-19 and identify factors associated with PICU admission and organ dysfunction. This is a retrospective chart review of 77 pediatric patients age 1 day to 21 years admitted to two New York City pediatric hospitals within the Northwell Health system between February 1 and April 24, 2020 with PCR + SARS-CoV-2. Descriptive statistics were used to describe the hospital course and laboratory results and bivariate comparisons were performed on variables to determine differences. Results Forty-seven patients (61%) were admitted to the general pediatric floor and thirty (39%) to the PICU. The majority (97%, n = 75) survived to discharge, 1.3% (n = 1) remain admitted, and 1.3% (n = 1) died. Common indications for PICU admission included hypoxia (50%), hemodynamic instability (20%), diabetic ketoacidosis (6.7%), mediastinal mass (6.7%), apnea (6.7%), acute chest syndrome in sickle cell disease (6.7%), and cardiac dysfunction (6.7%). Of PICU patients, 46.7% experienced any significant organ dysfunction (pSOFA > = 2) during admission. Patients aged 12 years or greater were more likely to be admitted to a PICU compared to younger patients (p = 0.015). Presence of an underlying comorbidity was not associated with need for PICU admission (p = 0.227) or organ dysfunction (p = 0.87). Initial white blood cell count (WBC), platelet count, and ferritin were not associated with need for PICU admission. Initial C-reactive protein was associated with both need for PICU admission (p = 0.005) and presence of organ dysfunction (p = 0.001). Initial WBC and presenting thrombocytopenia were associated with organ dysfunction (p = 0.034 and p = 0.003, respectively). Conclusions Age over 12 years and initial CRP were associated with need for PICU admission in COVID-19. Organ dysfunction was associated with elevated admission CRP, elevated WBC, and thrombocytopenia. These factors may be useful in determining risk for critical illness and organ dysfunction in pediatric COVID-19.

Download Full-text