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Clinical indications for Kawasaki disease in febrile infants aged less than three months

  • Observational Research
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Abstract

The purpose of this study was to determine the clinical and laboratory indicators of KD in febrile infants aged less than three months. Febrile infants aged less than three months were enrolled and divided into three groups: KD, bacterial infection (BI), and non-bacterial infection (NBI). Laboratory data were analyzed at two time points: initially upon admission and at follow-up after 48–72 h of admission. A total of 491 patients (280 males and 211 females) were enrolled. According to the final diagnosis, 29 patients had KD, 120 had BI, and 342 had NBI. The infants in the KD group were older (p < 0.001), had prolonged pre-admission and total fever duration (p < 0.001), and had a lower rate of decreased activity (p < 0.05) compared to the infants in the BI and NBI groups. The KD group had a significantly higher level of initial c-reactive protein (CRP) compared to the BI and NBI groups, with a cutoff value of 4.85 mg/dL in comparison with the BI group and 3.32 mg/dL in comparison with the NBI group. Moreover, the KD group had a significantly higher follow-up platelet count compared to the BI and NBI groups, with a cutoff value of 533 × 109/L in comparison with the BI group and 541 × 109/L in comparison with the NBI group. When febrile infants aged less than three months have prolonged fever, less decreased activity, and a higher initial CRP level and follow-up platelet count, we must consider the possibility of KD.

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Abbreviations

AHA:

American heart association

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

AUC:

Area under the curve

BI:

Bacterial infection

CI:

Confidence interval

CRP:

C-reactive protein

ESR:

Erythrocyte sedimentation rate

IVIG:

Intravenous immunoglobulin

KD:

Kawasaki disease

NBI:

Non-bacterial infection

NLR:

Neutrophil-to-lymphocyte ratio

NT-proBNP:

N-terminal pro-brain natriuretic peptide

PLR:

Platelet-to-lymphocyte ratio

ROC:

Receiver operating characteristic curve

WBC:

White blood cell

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No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Pediatrics, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea

    Duck Woo Lee & Hee Joung Choi

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  1. Duck Woo Lee
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  2. Hee Joung Choi
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Contributions

Conception, design of the study, and the collection and analysis of the data were performed by Lee DW and Choi HJ. The first draft of the manuscript was written by Lee DW. Ethical issues, statistical analysis, and comments to the first and subsequent versions of the manuscript were performed by Choi HJ. All authors read and approved the final manuscript.

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Correspondence to Hee Joung Choi.

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The authors declare that they have no conflicts of interest with respect to this work.

Ethics approval and consent to participate

This study is a retrospective and observational study and does not contain any studies with human participants or animals. This study was approved by the institutional review board of the Keimyung University Dongsan Medical Center (approval number: 2019-07-019).

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Lee, D.W., Choi, H.J. Clinical indications for Kawasaki disease in febrile infants aged less than three months. Rheumatol Int 42, 891–897 (2022). https://doi.org/10.1007/s00296-021-05019-7

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