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Three Part Question

In [children with suspected Kawasaki Disease], is [CRP] useful in [helping to make a diagnosis]?

Clinical Scenario

A 2 year old girl is brought in to the ED by her mother who is worried about the fever she has been having for the past 5 days. The little girl was also noted to have an enlarged lymph node on her neck which was not tender. She didn't have any history of sore throat or a previous URTI. The doctor treating her suspects Kawasaki Disease. Will a CRP level help confirm this diagnosis?

Search Strategy

Ovid MEDLINE(R) 1948 to June Week 3 2011 and
Embase 1980 to 2011 Week 25 and
CINAHL


[kawasaki.mp. OR exp Mucocutaneous Lymph Node Syndrome/di [Diagnosis]]

AND

[CRP.mp. OR C-reactive protein.mp. OR exp C-Reactive Protein/du [Diagnostic Use]

limit to (english language and humans and "all child (0 to 18 years)")

Search Outcome

137 papers were found in Medline, 272 in Embase and 5 results obtained from CINAHL.
Only 3 papers were relevant.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Koyanagi H. Yanagawa H. Nakamura Y. Yashiro M. 4/7/2011 Japan	11 040 patients who were diagnosed with Kawasaki disease between 1993 & 1994 with maximal serum CRP values	Cross sectional epidemiological study	To determine any association between maximal CRP value and diagnosis or prognosis of Kawasaki Disease	ROC curve showed that a cut-off value of 10 mg/dL in the age group 6 months to 1 year was closest to the upper left-hand corner. There was significantly a higher proportion of patients with typical cases of Kawasaki and a CRP level > 10 mg/dL (p<0.001).	Maximal serum CRP value was not stated
Ou C.-Y. Tseng Y.-F. Lee C.-L. Chiou Y.-H. Hsieh K.-S. 7/7/2011 Hong Kong	119 children with KD at least 1 year after diagnosis were classified into 2 groups: Group 1 (55 children with KD and coronary aneurysms) and Group 2 (64 children with KD and normal coronary arteries)	Retrospective cohort	Association between KD in children and serun high-sesitivity C-reactive protein	Serum hs-CRP levels in Group 1 (0.251 mg/dL) was significantly greater than that in Group 2 (0.162 mg/dL; p=0.011). There was a significant positive correlation between logarithmic h-CRP level and coronary artery lesion size (r=0.672, p=0.035))	Small sample size. No control group - this study does not include children without KD.
Mitani Y. Sawada H. Hayakawa H. Aoki K. Ohashi H. Matsumura M. Kuroe K. Shimpo H. Nakano M. Komada Y 7/7/2011 Japan	80 patients were studied, divided into 4 groups; Group 1 - the referent group (n=15); Group 2 - KD with normal coronary arteries (n=27); Group 3 - KD with regressed aneurysms (n=18) and Group 4 - KD with coronary artery lesions (n=20)	Cross-sectional study	Association between coronary artery lesion and elevated levels of inflammatory markers	Levels of CRP were higher in KD patients with persistent CALs (median and interquartile ranges: 0.29, 0.19 to 0.38mg/L) than in referents (0.09, 0.05 to 0.19 mg/L)(adjusted probability value, P=0.012), in KD patients with normal coronary arteries (0.13, 0.07 to 0.19 mg/L)(P=0.006) and in those with regressed aneurysms (0.11, 0.03 to 0.23 mg/L)(P=0.072). Logarithmically transformed levels of CRP were significantly higher in KD patients with persistent CALs than in referants and in KD patients with normal coronary arteries and with regressed aneurysms, as analyzed by ANOVA (P<0.05) and by ANCOVA (P<0.05).	Small sample size

Comment(s)

The papers aren't the best to answer the 3 part question. No study was found that directly evaluated CRP as a diagnostic tool for Kawasaki Disease. However it is evident that in patients with Kawasaki diease, their CRP level is high, especially patients with coronary artery lesions. Therefore, CRP may also be useful as a predictor marker of future coronary artery sequelae.

Clinical Bottom Line

CRP level is high in patients with Kawasaki Disease.

References

1. Koyanagi H. Yanagawa H. Nakamura Y. Yashiro M. Serum C-reactive protein levels in patients with Kawasaki disease: from the results of nation-wide surveys of Kawasaki disease in Japan. Acta Paediatrica. 1997
2. Ou C.-Y. Tseng Y.-F. Lee C.-L. Chiou Y.-H. Hsieh K.-S. Significant Relationship Between Serum High-sensitivity C-Reactive Protein, High-density Lipoprotein Cholesterol Levels and Children With Kawasaki Disease and Coronary Artery Lesions. Journal of the Formosan Medical Association 2009
3. Mitani Y. Sawada H. Hayakawa H. Aoki K. Ohashi H. Matsumura M. Kuroe K. Shimpo H. Nakano M. Komada Y. Elevated levels of high-sensitivity C-reactive protein and serum amyloid-A late after Kawasaki disease: association between inflammation and late coronary sequelae in Kawasaki disease. Circulation 2005