Parameters indicative of persistence of valvular pathology at initial diagnosis in acute rheumatic carditis: the role of albumin and CD19 expression

Oner, Taliha; Ozdemir, Rahmi; Genc, Dildar Bahar; Kucuk, Mehmet; Karadeniz, Cem; Demirpence, Savas; Yilmazer, Murat Muhtar; Mese, Timur; Tavli, Vedide; Genel, Ferah

doi:10.1016/j.jped.2016.01.013

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Original articles • J. Pediatr. (Rio J.) 92 (6) • Nov-Dec 2016 • https://doi.org/10.1016/j.jped.2016.01.013 copy

Parameters indicative of persistence of valvular pathology at initial diagnosis in acute rheumatic carditis: the role of albumin and CD19 expression^☆ ☆ Please cite this article as: Oner T, Ozdemir R, Genc DB, Kucuk M, Karadeniz C, Demirpence S, et al. Parameters indicative of persistence of valvular pathology at initial diagnosis in acute rheumatic carditis: the role of albumin and CD19 expression. J Pediatr (Rio J). 2016;92:581-7.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

The aim of this study is to define the predictors of chronic carditis in patients with acute rheumatic carditis (ARC).

Methods:

Patients diagnosed with ARC between May 2010 and May 2011 were included in the study. Echocardiography, electrocardiography, lymphocyte subset analysis, acute phase reactants, plasma albumin levels, and antistreptolysin-O (ASO) tests were performed at initial presentation. The echocardiographic assessments were repeated at the sixth month of follow-up. The patients were divided into two groups according to persistence of valvular pathology at 6th month as Group 1 and Group 2, and all clinical and laboratory parameters at admission were compared between two groups of valvular involvement.

Results:

During the one-year study period, 22 patients had valvular disease. Seventeen (77.2%) patients showed regression in valvular pathology. An initial mild regurgitation disappeared in eight patients (36.3%). Among seven (31.8%) patients with moderate regurgitation initially, the regurgitation disappeared in three, and four patients improved to mild regurgitation. Two patients with a severe regurgitation initially improved to moderate regurgitation (9.1%). In five (22.8%) patients, the grade of regurgitation [moderate regurgitation in one (4.6%), and severe regurgitation in 4 (18.2%)] remained unchanged. The albumin level was significantly lower at diagnosis in Group 2 (2.6 ± 0.48 g/dL). Lymphocyte subset analysis showed a significant decrease in the CD8 percentage and a significant increase in CD19 percentage at diagnosis in Group 2 compared to Group 1.

Conclusion:

The blood albumin level and the percentage of CD8 and CD19 (+) lymphocytes at diagnosis may help to predict chronic valvular disease risk in patients with acute rheumatic carditis.

KEYWORDS
Acute rheumatic carditis; Albumin; CD8; CD19; Lymphocyte subtypes

Characteristics
Age (years), mean ± SD (range)	12.23 ± 2.1
Male gender	22 (54.5% male)
Body weight (kg), mean ± SD	42.4 ± 17.9

Presence of major criteria
Arthritis	18/22 (81.8%)
Chorea	0/22 (0%)

Presence of minor criteria
Fever	10/22 (45.4%)
Arthralgia	3/22 (13.6%)
Prolonged PR interval	4/22 (18.1%)
Elevated acute phase reactants	22/22 (100%)

Laboratory findings
Hemoglobin (g/dL)	10.49 ± 1.35
WBC (/mm³)	10.79 ± 3.91
Platelet (1000/mm³)	409 ± 115
ESR (h)	106 ± 26
ASO (IU/mL)	1175 ± 425
Albumin (g/dL)	3.21 ± 0.55

Echocardiography
FS%	42.9 ± 4.5

Electrocardiography
Heart rate (pulse/min)	91.10 ± 20.27
QTc dispersion (ms)	42.7 ± 17.5
PR distance (sec)	0.15 ± 0.04

Lymphocyte subset analysis
CD8 (%)	25.65 ± 6.14
CD19 (%)	21.11 ± 8.72

Variable	Group 1	Group 2	p
Number	17 (77.2%)	5 (22.8%)
Age range (mean/years)	12 ± 1.8	13 ± 3.2	NS
Sedimentation (h)	104.1 ± 25.7	113.6 ± 29.4	NS
ASO (IU/mL)	1192 ± 438	1118 ± 418	NS
White blood cell (/mm³)	10.27 ± 3.9	12.56 ± 3.58	NS
Hemoglobin (g/dL)	10.75 ± 1.36	9.6 ± 0.91	NS
Platelet (1000/mm³)	397 ± 92	451 ± 182.3	NS
Albumin (g/dL)	3.3 ± 0.45	2.6 ± 0.48	0.003
Fractional shortening (%)	43.6 ± 4.6	40.0 ± 2.9	NS
LVEDd (cm)	4.66 ± 0.61	4.55 ± 0.20	NS
ECG - Heart rate	86.2 ± 15.2	111.5 ± 28.5	NS
ECG - QTc dispersion (sec)	0.042 ± 0.019	0.044 ± 0.011	NS
ECG - PR distance (sec)	0.149 ± 0.040	0.152 ± 0.046	NS

	Initial		After six-months		Recovery
	Mitral regurgitation	Aortic regurgitation	Mitral regurgitation	Aortic regurgitation
Case 1	Mild	Absent	Absent	Absent	+
Case 2	Mild	Mild	Absent	Absent	+
Case 3	Mild	Mild	Absent	Absent	+
Case 4	Mild	Absent	Absent	Absent	+
Case 5	Moderate	Mild	Absent	Mild	+
Case 6	Mild	Moderate	Mild	Moderate	−
Case 7	Moderate	Mild	Mild	Mild	+
Case 8	Severe	Moderate	Severe	Moderate	−
Case 9	Absent	Mild	Absent	Absent	+
Case 10	Mild	Absent	Absent	Absent	+
Case 11	Moderate	Mild	Mild	Absent	+
Case 12	Severe	Absent	Severe	Absent	−
Case 13	Mild	Moderate	Absent	Absent	+
Case 14	Moderate	Mild	Absent	Absent	+
Case 15	Severe	Mild	Moderate	Mild	+
Case 16	Absent	Mild	Absent	Absent	+
Case 17	Moderate	Moderate	Mild	Mild	+
Case 18	Moderate	Mild	Absent	Absent	+
Case 19	Severe	Mild	Moderate	Absent	+
Case 20	Severe	Absent	Severe	Absent	−
Case 21	Mild	Mild	Absent	Mild	+
Case 22	Severe	Mild	Severe	Mild	−

Variable	Group 1 (n = 17)	Group 2 (n = 5)	p
Lymphocyte count	2178 ± 1024	1819 ± 946	NS
CD3 (%)	67.35 ± 9.3	58.08 ± 13.7	NS
CD4 (%)	35.82 ± 7.5	32.8 ± 6.47	NS
CD8 (%)	27.63 ± 5.88	20.56 ± 1.9	0.017
CD4/CD8	1.35 ± 0.39	1.62 ± 0.34	NS
CD19 (%)	19.35 ± 7.5	29.6 ± 6.5	0.013

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[1] * Corresponding author. E-mail:rahmiozdemir35@gmail.com (R. Ozdemir).