C-reactive protein and N-terminal pro-brain natriuretic peptide discrepancy: a differentiation of adenoviral pharyngoconjunctival fever from Kawasaki disease원문보기
Purpose: To differentiate adenoviral pharyngoconjunctival fever (PCF) from acute Kawasaki disease (KD) using laboratory tests before results of virus-real time polymerase chain reaction and ophthalmologic examination are obtained. Methods: Baseline patient characteristics and laboratory measurements...
Purpose: To differentiate adenoviral pharyngoconjunctival fever (PCF) from acute Kawasaki disease (KD) using laboratory tests before results of virus-real time polymerase chain reaction and ophthalmologic examination are obtained. Methods: Baseline patient characteristics and laboratory measurements were compared between 40 patients with adenovirus infection and 123 patients with KD. Results: The patients with adenovirus infection were generally older than those with KD (median: 3.9 years vs. 2 years, P=0.000). White blood cell and, platelet count, and aspartate aminotransferase, alanine aminotransferase, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels showed significant differences between the 2 groups, but the C-reactive protein (CRP) levels did not ($6.8{\pm}3.0mg/dL$ vs. $8.3{\pm}5.8mg/dL$, P=0.126). In the adenovirus infection group, the CRP levels were <1, <3, <10, and ${\geq}10mg/dL$ in 2 (5%), 3 (7.5%), 30 (75%), and 5 patients (12.5%), respectively. The cutoff NT-proBNP level was 265 pg/mL. Discrepancy was defined as CRP and NT-proBNP levels of ${\geq}3$ or <3 mg/dL, and <265 or ${\geq}265pg/mL$, respectively. Among the 35 patients with adenovirus infection whose CRP levels were ${\geq}3mg/dL$, 29 (82.9%) showed a discrepancy. Conversely, of the 103 patients with KD whose CRP levels were ${\geq}3mg/dL$, 83 (80.6%) showed no discrepancy. Between the groups, a significant difference in discrepancy rate was observed (P=0.000). None of the patients with adenovirus infection had CRP and NT-proBNP levels of <3 mg/dL and ${\geq}265pg/mL$, respectively. Conclusion: With a sensitivity of 82.9% and a specificity of 80.6%, CRP and NT-proBNP levels may differentiate between adenoviral PCF and acute KD.
Purpose: To differentiate adenoviral pharyngoconjunctival fever (PCF) from acute Kawasaki disease (KD) using laboratory tests before results of virus-real time polymerase chain reaction and ophthalmologic examination are obtained. Methods: Baseline patient characteristics and laboratory measurements were compared between 40 patients with adenovirus infection and 123 patients with KD. Results: The patients with adenovirus infection were generally older than those with KD (median: 3.9 years vs. 2 years, P=0.000). White blood cell and, platelet count, and aspartate aminotransferase, alanine aminotransferase, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels showed significant differences between the 2 groups, but the C-reactive protein (CRP) levels did not ($6.8{\pm}3.0mg/dL$ vs. $8.3{\pm}5.8mg/dL$, P=0.126). In the adenovirus infection group, the CRP levels were <1, <3, <10, and ${\geq}10mg/dL$ in 2 (5%), 3 (7.5%), 30 (75%), and 5 patients (12.5%), respectively. The cutoff NT-proBNP level was 265 pg/mL. Discrepancy was defined as CRP and NT-proBNP levels of ${\geq}3$ or <3 mg/dL, and <265 or ${\geq}265pg/mL$, respectively. Among the 35 patients with adenovirus infection whose CRP levels were ${\geq}3mg/dL$, 29 (82.9%) showed a discrepancy. Conversely, of the 103 patients with KD whose CRP levels were ${\geq}3mg/dL$, 83 (80.6%) showed no discrepancy. Between the groups, a significant difference in discrepancy rate was observed (P=0.000). None of the patients with adenovirus infection had CRP and NT-proBNP levels of <3 mg/dL and ${\geq}265pg/mL$, respectively. Conclusion: With a sensitivity of 82.9% and a specificity of 80.6%, CRP and NT-proBNP levels may differentiate between adenoviral PCF and acute KD.
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제안 방법
A multivariate logistic regression analysis included age, WBC, platelet, AST, ALT, and NT-proBNP. Among them, WBC, platelet, and NT-proBNP proved to be the independent parameters for differentiation (Table 3).
Limitations of this study include a small number of adenovirus subjects and the retrospective nature of this study, which may lead to case exclusion due to data omission. The study was performed at different times in each group.
대상 데이터
In this study, of the 40 patients who were diagnosed as adenoviral PCF during the 3-month epidemic period, conjunctival injection was present in 23 patients. This group of patients may be criticized as not PCF patients.
데이터처리
When the variables in either group are not normally distributed, Mann-Whitney test was used. Categorical variables were compared using the chi-square test. To determine the cutoff values of parameters, a receiver operating characteristic (ROC) curve was used.
Data are presented as the median, as well as the mean±standard deviation, or as numbers and percentages of patients. Continuous variables between the groups were compared using Student t test. When the variables in either group are not normally distributed, Mann-Whitney test was used.
To determine the cutoff values of parameters, a receiver operating characteristic (ROC) curve was used. Multivariate logistic regression analysis was performed using age plus laboratory variables that had been selected by univariate analysis to determine the independent parameters in differentiating the groups, and the results were expressed as an odds ratio with a 95% confidence interval (CI). A 95% CI that did not include 1.
이론/모형
Continuous variables between the groups were compared using Student t test. When the variables in either group are not normally distributed, Mann-Whitney test was used. Categorical variables were compared using the chi-square test.
성능/효과
In conclusion, CRP and NT-proBNP discrepancy may simply and quickly discriminate adenoviral PCF from acute KD, with a sensitivity of 82.9% and a specificity of 80.6%. We cautiously propose the use of CRP and NT-proBNP discrepancy in the differential diagnosis to distinguish between incomplete KD and adenoviral PCF.
참고문헌 (12)
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