title: Low tissue plasminogen activator relative to plasminogen activator inhibitor-1 as a marker of cardiac complication in children with Kawasaki disease.
abstract: To determine whether the fibrinolytic system is related to the occurrence of cardiac complication in Kawasaki disease, we measured tissue plasminogen activator, plasminogen activator inhibitor-1, and related factors in the plasma of children with Kawasaki disease. Patients (mean age, 1.8 years) were classified into patients with cardiac complication (n = 9) and no complication (n = 14) groups echocardiographically. They underwent single, high-dose, intravenous-gamma-globulin infusion therapy. Blood was drawn just before and the day after the single high-dose intravenous gamma-globulin infusion therapy (acute phase), and at early and late convalescent phases. Leukocytosis was normalized immediately after the single, high-dose, intravenous gamma-globulin infusion therapy. C-reactive protein and fibrinogen were increased in the acute phase and normalized by convalescent phases. D-dimer fraction of fibrin degradation products changed in a similar manner. Tissue plasminogen activator and plasminogen activator inhibitor-1 were increased in acute phase. The tissue plasminogen activator/plasminogen activator inhibitor-1 ratio was lower in the complication group than in the no complication group throughout the observation period (0.095 versus 0.208 after single, high-dose, intravenous gamma-globulin infusion therapy, p = 0.006; 0.094 versus 0.183 at late convalescent phase, p = 0.024). A low tissue plasminogen activator/plasminogen activator inhibitor-1 ratio can predict the propensity for cardiac complication, and can help the physician to decide whether additional therapies are necessary in acute phase Kawasaki disease.
authors.affiliation: Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Sakai
authors.forename: K
authors.initials: K
authors.lastname: Asayama
authors.forename: T
authors.initials: T
authors.lastname: Otabe
authors.forename: T
authors.initials: T
authors.lastname: Kohri
authors.forename: A
authors.initials: A
authors.lastname: Shirahata
mesh_terms: D000208:Acute Disease; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D002675:Child, Preschool; D003289:Convalescence; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D006331:Heart Diseases / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood* / Q000150:complications / Q000628:therapy; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D010959:Tissue Plasminogen Activator / Q000032:analysis*; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D016756:Immunoglobulins, Intravenous; D017395:Plasminogen Activator Inhibitor 1; C036309:fibrin fragment D; D005340:Fibrinogen; D002097:C-Reactive Protein; D010959:Tissue Plasminogen Activator