Abstract:

Objective To evaluate the value of white blood cell count (WBC), C reactive protein (CRP) and glucose of peripheral blood in detection of severe hand, foot and mouth disease (HFMD) with neurological involvement , and to provide the reference for clinical diagnosis of severe HFMD. Methods The sick children with HFMD admitted to Children's Hospital of Fudan University from Jan 2009 to Dec 2010, were recruited and divided into the mild HFMD (stage 1) and the severe HFMD (stage 2) according to HFMD clinical criterion. All the cases were reviewed by Electronic Medical Record. Severe HFMD in this research were those with neurological involvement but not patients with cardiopulmonary dysfunction. WBC, CRP and glucose of all the patients were collected on the first day of admission, and compared by using stata 10.0 software. Receiver operating characteristic (ROC) analysis was performed. The best diagnostic value was found by calculating their area under the curve (AUC) and Youden index. Results ①A total of 920 patients were recruited into this study. 681 patients were categorized into stage 1 and 239 patients were categorized into stage 2. ②WBC, CRP and glucose of these two groups were all in abnormal distribution. The median WBC was 11.4×109·L-1(range 3.1×109·L-1-39.8×109·L-1) and 11.3×109·L-1(range 4.9×109·L-1- 26.3×109·L-1) for stage-1 subjects and stage-2 subjects, respectively. . The median CRP of two groups was both 8mg·L-1 (stage 1 range: 8-160mg·L-1, stage 2 range: 8-77 mg·L-1). The median glucose of stage 1 was 5.0mmol·L-1 (range 3.5-11.7 mmol·L-1), and of stage 2 was 5.6 mmol·L-1 (range 3.5-15.7 mmol·L-1). (3) Using student-t test to analyze WBC after log transformtaion, there was no significant difference in WBC between two groups (P=0.427). Non-parametric test was used to analyze CRP and glucose, the results showed significant difference (P<0.001). (4) AUC of WBC, CRP and glucose was 0.512, 0.405 and 0.625. The best diagnostic value of WBC was 7.85×109·L-1 (sensitivity 88.7%, specificity 18.4%). The best diagnostic value of glucose was 5.25 mmol·L-1 (sensitivity 60.7%, specificity 59.0%). (5) Combining two best diagnostic values and using diagnostic testing, achieving sensitivity of 37.3% and specificity of 81.2%. Conclusion WBC counts and glucose levels showed low validity in detection of severe HFMD with neurological involvement. CRP levels could not to be used to predict severe HFMD. Serial test in this research did not increase the diagnostic validity. Clinical doctors should pay more attention to clinical features and signs.

Key words: Children, C-reactive protein, Glucose, hand-food-mouth disease, Nervous system damage, White blood cell count