Laboratory markers indicating gastrointestinal involvement of henoch-schönlein purpura in children

Abstract

Purpose: To determine clinically useful biochemical markers reflecting disease activity and/or gastrointestinal (GI) tract involvement in Henoch-Schönlein purpura (HSP).

Methods: A total of 185 children with HSP and 130 controls were included. Laboratory data indicating inflammation, standard coagulation, and activated coagulation were analyzed for the HSP patients, including measurements of the hemoglobin level, white blood cell (WBC) count, absolute neutrophil count (ANC), platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, prothrombin time, activated partial thromboplastin time, and fibrinogen, D-dimer, and fibrin degradation product (FDP) levels. The clinical scores of the skin, joints, abdomen, and kidneys were assessed during the acute and convalescence phases of HSP.

Results: The WBC count, ANC, ESR, and CRP, fibrinogen, D-dimer, and FDP levels were significantly higher in the acute phase compared with the convalescent phase of HSP (p<0.05). The total clinical scores were more strongly correlated with the D-dimer (r=0.371, p<0.001) and FDP (r=0.369, p<0.001) levels than with inflammatory markers, such as the WBC count (r=0.241, p=0.001), ANC (r=0.261, p<0.001), and CRP (r=0.260, p<0.001) levels. The patients with GI symptoms had significantly higher ANC (median [interquartile range], 7,138.0 [4,446.4-9,470.0] vs. 5,534.1 [3,263.0-8,153.5], p<0.05) and CRP (0.49 [0.15-1.38] vs. 0.23 [0.01-0.67], p<0.05), D-dimer (2.63 [1.20-4.09] vs. 1.75 [0.62-3.39]), and FDP (7.10 [0.01-13.65] vs. 0.10 [0.01-7.90], p<0.05) levels than those without GI symptoms.

Conclusion: D-dimer and FDPs are more strongly associated with disease activity and more consistently reflect GI involvement than inflammatory markers during the acute phase of HSP.

Keywords: Blood coagulation; Child; Fibrin fibrinogen degradation products; Fibrin fragment D; Inflammation; Purpura; Schönlein-Henoch.

Fig. 1. Comparison of the levels of (A) fibrinogen, (B) D-dimer and (C) fibrin degradation products (FDPs) among the patients of acute phase, convalescent phase, and healthy controls. The fibrinogen, D-dimer, and FDP levels during the acute phase of the patients were significantly higher than during the convalescent phase and those in the control group (p<0.05).

Fig. 2. Comparison of the levels of (A) white blood cell (WBC), (B) absolute neutrophil count (ANC), (C) C-reactive protein (CRP), (D) D-dimer, and (E) fibrin degradation products (FDPs) among the patients categorized according to the abdominal score of Henoch-Schönlein purpura. The ANC, CRP, D-dimer, and FDP levels were significantly higher in the patients with gastrointestinal (GI) symptoms (abdominal scores of 1-3) than those without GI symptoms (abdominal score of 0) (p<0.05). The patients with significant GI symptoms (abdominal scores of 2-3) had higher WBC counts, ANC, CRP, D-dimer, and FDP levels than those without GI symptoms (abdominal score of 0) (p<0.05). GI symptom: no, abdominal score 0; mild, abdominal score 1; significant, abdominal score 2-3.