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J Korean Soc Emerg Med > Volume 29(1); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(1): 37-43.
경부임파선 비대가 첫 증상인 가와사키병과 세균성 경부임파선염의 감별진단에서 N-terminal pro-brain natriuretic peptide의 역할
황일웅1, 이동욱1, 김재우1, 박세훈1, 이정원1, 문형준1, 최재형1, 이현정1, 정윤현1, 김현수1, 전덕호2
1순천향대학교 천안병원 응급의학과
2순천향대학교 구미병원 응급의학과
Role of N-terminal Pro-brain Natriuretic Peptide in Differentiating Node-first Presentations of Kawasaki Disease and Bacterial Cervical Lymphadenitis
Il Woong Hwang1, Dong Wook Lee1, Jae Woo Kim1, Sae Hoon Park1, Jung Won Lee1, Hyung Jun Moon1, Jae Hyung Choi1, Hyun Jung Lee1, Yoon Hyun Jung1, Hyun Su Kim1, Duck Ho Jun2
1Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
2Department of Emergency Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi, Korea
Correspondence  Dong Wook Lee ,Tel: 041-570-2119, Fax: 041-592-3806, Email: yisfm83@gmail.com,
Received: July 1, 2017; Revised: July 3, 2017   Accepted: November 8, 2017.  Published online: February 28, 2018.
ABSTRACT
Purpose:
Kawasaki disease (KD) is an acute, self-limited, febrile disease. For cases of KD in which the first symptom is cervical lymphadenopathy (node-first presentations of KD, NFKD), it is frequently misdiagnosed as bacterial cervical lymphadenitis (BCL). Therefore, we evaluated the usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) to differentiate between NFKD and BCL.
Method:
This is a retrospective, observational study. Patients were divided into three groups, KD as 1st diagnosis, NFKD, and BCL. The laboratory and demographic data, intravenous immunoglobulin (IVIG) administration time and total febrile duration, length of hospital stay, and number of coronary artery complications were then compared for each group.
Results
A total of 451 patients were diagnosed as KD and 45 patients as BCL. Of the 451 KD patients, 417 (92.5%) were KD as 1st diagnosis, and 34 (7.5%) were NFKD. White blood cell count, absolute neutrophil count, C-reactive protein, erythrocyte sedimentation rate, and NT-proBNP differed significantly between NFKD and BCL. Variables that differed significantly were analyzed using a receiver operating characteristic curve, which revealed that NT-proBNP had the largest area under curve (0.944). Additionally, IVIG administration time, total febrile duration and length of hospital stay differed between KD as 1st diagnosis and NFKD.
Conclusion:
It is difficult to differentiate NFKD from BCL, so proper treatment and length of hospital stay were delayed. NT-proBNP is very useful for differentiating NFKD and BCL. Therefore, in cases of BCL with a long febrile period without reacting general treatments, the NT-proBNP test can be considered.
Key words: Mucocutaneous lymph node syndrome, Lymphadenitis, Diagnosis, differential
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