The relevance of the serum levels of C-reactive protein and creatine kinase-MB to the severity of hand-foot-and-mouth disease patients in China: A meta-analysis

ObjectiveThe goal of this meta-analysis was to determine whether the serum levels of C-reactive protein (CRP) and creatine kinase-MB (CK-MB) are correlated with the severity of hand-foot-and-mouth disease (HFMD).MethodsWe conducted a systematic search and meta-analysis of the MEDLINE, PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, VIP information, and Wanfang Chinese Periodical databases. The analysis included all published case–control, cohort, and cross-sectional studies of serum CRP and/or CK-MB levels in children with HFMD up to December 4, 2014. Pooled estimates were calculated using a random-effects model or a fixed-effects model.ResultsThirty-eight articles are included in this meta-analysis. The summary estimates revealed that the average serum CRP levels, prevalence of high CRP, average serum CK-MB levels, and prevalence of high CK-MB increased with the severity of HFMD. There were no significant differences in the average levels of serum CK-MB (pooled MD = 22.29 U/L; 95% CI: −0.82–45.39 U/L, P = 0.06) between patients who were critically ill and those with severe HFMD. Therefore, we compared the average levels of serum CRP (pooled MD = 1.17 mg/L; 95% CI: −0.88–3.21 mg/L, P = 0.26) between patients infected with enterovirus 71 and those infected with coxsackievirus A16.ConclusionsThe result of these analyses indicated that the CRP and CK-MB levels are correlated with HFMD severity. Thus, these frequently used and accessible measures may aid clinicians in effectively diagnosing, treating, and predicting the prognosis of children with HFMD.