Erythrocyte sedimentation rate and C-reactive protein discrepancy and high prevalence of coronary artery abnormalities in Kawasaki disease

Abstract

Background: An outbreak of Kawasaki disease (KD) in Colorado between November, 1997, and June, 1998, provided the opportunity to study inflammatory indices and coronary artery abnormalities.

Methods: Medical records of the 33 patients diagnosed with KD at The Children's Hospital during the outbreak were reviewed. Demographic and clinical information, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and echocardiogram results were recorded. Traditional abnormalities (dilatation, aneurysm, ectasia), as well as "prominence" of the coronary arteries were noted.

Results: Twenty-five patients had CRP and ESR performed on the day of admission; 11 of 25 (44%) had a discrepancy between the height of the ESR and CRP values (high ESR and low CRP or low ESR and high CRP). The mean CRP was higher in patients who presented in <10 days than in patients who presented in > or =10 days: 13.9 mg/dl vs. 5.2 mg/dl (P = 0.01). The ESR value did not correlate with the day of illness. Age, gender or presence of coronary artery abnormalities did not correlate with the height of CRP or ESR elevation. Thirty percent of patients had at least one abnormality on their initial echocardiogram (dilatation, aneurysm, ectasia). An additional 24% of patients displayed prominence as the only finding on their initial echocardiogram. Of the 33 patients 7 (21.2%) had coronary artery aneurysms.

Conclusions: Many patients with KD have discrepancies in the degree of elevation of CRP and ESR. Physicians should consider obtaining both tests in patients with KD. This outbreak was associated with a high degree of coronary artery abnormalities. The finding of coronary artery prominence is an observation that deserves further study.