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Wu Y, Yin W, Wen Y, Chen J, Tang H, Ding Y. An early predictive model for Kawasaki disease shock syndrome in children in central China. Front Cardiovasc Med 2024; 11:1405012. [PMID: 38859816 PMCID: PMC11163032 DOI: 10.3389/fcvm.2024.1405012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/09/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction This study aims to analyze the clinical features of Kawasaki disease (KD) shock syndrome (KDSS) and explore its early predictors. Methods A retrospective case-control study was used to analyze KD cases from February 2016 to October 2023 in our hospital. A total of 28 children with KDSS and 307 children who did not develop KDSS were included according to matching factors. Baseline information, clinical manifestations, and laboratory indicators were compared between the two groups. Indicators of differences were analyzed based on univariate analysis; binary logistic regression analysis was used to identify the risk factors for KDSS, and then receiver operating characteristic analysis was performed to establish a predictive score model for KDSS. Results Elevated neutrophil-to-lymphocyte ratio(NLR) and decreased fibrinogen (FIB) and Na were independent risk factors for KDSS; the scoring of the above risk factors according to the odds ratio value eventually led to the establishment of a new scoring system: NLR ≥ 7.99 (6 points), FIB ≤ 5.415 g/L (1 point), Na ≤ 133.05 mmol/L (3 points), and a total score of ≥3.5 points were high-risk factors for progression to KDSS; otherwise, they were considered to be low-risk factors. Conclusion Children with KD with NLR ≥ 7.99, FIB ≤ 5.415 g/L, and Na ≤ 133.05 mmol/L, and those with two or more of the above risk factors, are more likely to progress to KDSS, which helps in early clinical diagnosis and treatment.
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Affiliation(s)
| | | | | | | | - Hongxia Tang
- Department of Rheumatology and Immunology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yan Ding
- Department of Rheumatology and Immunology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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2
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Zhang M, Wang C, Li Q, Wang H, Li X. Risk factors and an early predictive model for Kawasaki disease shock syndrome in Chinese children. Ital J Pediatr 2024; 50:22. [PMID: 38310292 PMCID: PMC10837898 DOI: 10.1186/s13052-024-01597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Kawasaki disease shock syndrome (KDSS), though rare, has increased risk for cardiovascular complications. Early diagnosis is crucial to improve the prognosis of KDSS patients. Our study aimed to identify risk factors and construct a predictive model for KDSS. METHODS This case-control study was conducted from June, 2015 to July, 2023 in two children's hospitals in China. Children initially diagnosed with KDSS and children with Kawasaki disease (KD) without shock were matched at a ratio of 1:4 by using the propensity score method. Laboratory results obtained prior to shock syndrome and treatment with intravenous immunoglobulin were recorded to predict the onset of KDSS. Univariable logistic regression and forward stepwise logistic regression were used to select significant and independent risk factors associated with KDSS. RESULTS After matching by age and gender, 73 KDSS and 292 KD patients without shock formed the development dataset; 40 KDSS and 160 KD patients without shock formed the validation dataset. Interleukin-10 (IL-10) > reference value, platelet counts (PLT) < 260 × 109/L, C-reactive protein (CRP) > 80 mg/ml, procalcitonin (PCT) > 1ng/ml, and albumin (Alb) < 35 g/L were independent risk factors for KDSS. The nomogram model including the above five indicators had area under the curves (AUCs) of 0.91(95% CI: 0.87-0.94) and 0.90 (95% CI: 0.71-0.86) in the development and validation datasets, with a specificity and sensitivity of 80% and 86%, 66% and 77%, respectively. Calibration curves showed good predictive accuracy of the nomogram. Decision curve analyses revealed the predictive model has application value. CONCLUSIONS This study identified IL-10, PLT, CRP, PCT and Alb as risk factors for KDSS. The nomogram model can effectively predict the occurrence of KDSS in Chinese children. It will facilitate pediatricians in early diagnosis, which is essential to the prevention of cardiovascular complications.
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Affiliation(s)
- Mingming Zhang
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 10020, China
| | - Congying Wang
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 10020, China
- Department of Cardiology, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Qirui Li
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Hongmao Wang
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 10020, China
| | - Xiaohui Li
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 10020, China.
- Department of Cardiology, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China.
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Biesbroek G, Kapitein B, Kuipers IM, Gruppen MP, van Stijn D, Peros TE, van Veenendaal M, Jansen MHA, van der Zee CW, van der Kuip M, von Asmuth EGJ, Mooij MG, den Boer MEJ, Landman GW, van Houten MA, Schonenberg-Meinema D, Tutu van Furth AM, Boele van Hensbroek M, Scherpbier H, van Meijgaarden KE, Ottenhoff THM, Joosten SA, Ketharanathan N, Blink M, Brackel CLH, Zaaijer HL, Hombrink P, van den Berg JM, Buddingh EP, Kuijpers TW. Inflammatory responses in SARS-CoV-2 associated Multisystem Inflammatory Syndrome and Kawasaki Disease in children: An observational study. PLoS One 2022; 17:e0266336. [PMID: 36449533 PMCID: PMC9710748 DOI: 10.1371/journal.pone.0266336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/19/2022] [Indexed: 12/05/2022] Open
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe inflammatory disease in children related to SARS-CoV-2 with multisystem involvement including marked cardiac dysfunction and clinical symptoms that can resemble Kawasaki Disease (KD). We hypothesized that MIS-C and KD might have commonalities as well as unique inflammatory responses and studied these responses in both diseases. In total, fourteen children with MIS-C (n=8) and KD (n=6) were included in the period of March-June 2020. Clinical and routine blood parameters, cardiac follow-up, SARS-CoV-2-specific antibodies and CD4+ T-cell responses, and cytokine-profiles were determined in both groups. In contrast to KD patients, all MIS-C patients had positive Spike protein-specific CD3+CD4+ T-cell responses. MIS-C and KD patients displayed marked hyper-inflammation with high expression of serum cytokines, including the drug-targetable interleukin (IL)-6 and IFN-γ associated chemokines CXCL9, 10 and 11, which decreased at follow-up. No statistical differences were observed between groups. Clinical outcomes were all favourable without cardiac sequelae at 6 months follow-up. In conclusion, MIS-C and KD-patients both displayed cytokine-associated hyper-inflammation with several high levels of drug-targetable cytokines.
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Affiliation(s)
- G. Biesbroek
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - B. Kapitein
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - I. M. Kuipers
- Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - M. P. Gruppen
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - D. van Stijn
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - T. E. Peros
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - M. van Veenendaal
- Department of Pediatric Immunology and Infectious Disease, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M. H. A. Jansen
- Department of Pediatric Immunology and Infectious Disease, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - M. van der Kuip
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - E. G. J. von Asmuth
- Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - M. G. Mooij
- Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - M. E. J. den Boer
- Department of Pediatrics, Medical Spectrum Twente, Enschede, The Netherlands
| | - G. W. Landman
- Department of Internal medicine, Gelre Hospital, Apeldoorn, The Netherlands
| | - M. A. van Houten
- Department of Pediatrics, Spaarne Hospital, Haarlem, The Netherlands
| | - D. Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - A. M. Tutu van Furth
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - M. Boele van Hensbroek
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - H. Scherpbier
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - K. E. van Meijgaarden
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - T. H. M. Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - S. A. Joosten
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - N. Ketharanathan
- Department of Pediatric Surgery and Intensive Care, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - M. Blink
- Pediatric Intensive Care Unit, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - C. L. H. Brackel
- Department of Pediatrics, Hilversum, The Netherlands
- Department of Pediatric Pulmonology, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - H. L. Zaaijer
- Department of Virology, Sanquin Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - P. Hombrink
- Department of Blood Cell Research, Sanquin Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - J. M. van den Berg
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - E. P. Buddingh
- Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - T. W. Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Blood Cell Research, Sanquin Research Institute, University of Amsterdam, Amsterdam, The Netherlands
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Lehtiranta S, Honkila M, Anttila S, Huhtamäki H, Pokka T, Tapiainen T. The incidence, hospitalisations and deaths in acutely ill children with dysnatraemias. Acta Paediatr 2022; 111:1630-1637. [PMID: 35373375 PMCID: PMC9542083 DOI: 10.1111/apa.16348] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Abstract
Aim The aim was to evaluate the incidence, hospitalisations and deaths in acutely ill children with dysnatraemias. Methods This was a register‐based cohort study of 46 518 acutely ill children aged <16 years who visited a paediatric emergency department. Risk factors were assessed using two nested case–control studies. Results Moderate to severe hypernatraemia occurred in 92 children (0.20%; 95% confidence interval [CI]: 0.16%–0.24%) and moderate to severe hyponatraemia in 131 children (0.28%; 95% CI: 0.24%–0.33%). Underlying medical conditions increased the risk of both moderate to severe hypernatraemia (odds ratio [OR]: 17; 95% 5.5–51) and moderate to severe hyponatraemia (OR: 3.5; 95% CI: 2.0–5.9). The use of a feeding tube (OR: 14; 95% CI: 3.2–66) and intellectual disability (OR: 7.3; 95% CI: 3.0–18) was associated with moderate to severe hypernatraemia. The risk of death was associated with moderate to severe hypernatraemia (OR: 19; 95% CI: 2.0–2564) and moderate to severe hyponatraemia (OR: 33; 95% CI: 3.7–4311). Conclusions Severe dysnatraemias were more prevalent in acutely ill children with underlying medical conditions and were markedly associated with the risk for death.
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Affiliation(s)
- Saara Lehtiranta
- Department of Paediatrics and Adolescent Medicine Oulu University Hospital Oulu Finland
- PEDEGO (Paediatrics, Dermatology, Gynecology, Obstetrics) Research Unit and Medical Research Centre Oulu University of Oulu Oulu Finland
| | - Minna Honkila
- Department of Paediatrics and Adolescent Medicine Oulu University Hospital Oulu Finland
- PEDEGO (Paediatrics, Dermatology, Gynecology, Obstetrics) Research Unit and Medical Research Centre Oulu University of Oulu Oulu Finland
| | - Silja Anttila
- PEDEGO (Paediatrics, Dermatology, Gynecology, Obstetrics) Research Unit and Medical Research Centre Oulu University of Oulu Oulu Finland
| | - Heikki Huhtamäki
- Department of Paediatrics and Adolescent Medicine Oulu University Hospital Oulu Finland
- PEDEGO (Paediatrics, Dermatology, Gynecology, Obstetrics) Research Unit and Medical Research Centre Oulu University of Oulu Oulu Finland
| | - Tytti Pokka
- Department of Paediatrics and Adolescent Medicine Oulu University Hospital Oulu Finland
- PEDEGO (Paediatrics, Dermatology, Gynecology, Obstetrics) Research Unit and Medical Research Centre Oulu University of Oulu Oulu Finland
| | - Terhi Tapiainen
- Department of Paediatrics and Adolescent Medicine Oulu University Hospital Oulu Finland
- PEDEGO (Paediatrics, Dermatology, Gynecology, Obstetrics) Research Unit and Medical Research Centre Oulu University of Oulu Oulu Finland
- Biocenter Oulu University of Oulu Oulu Finland
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5
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Zheng Z, Huang Y, Wang Z, Tang J, Chen X, Li Y, Li M, Zang C, Wang Y, Wang L, Ma Y, Sun L. Clinical Features in Children With Kawasaki Disease Shock Syndrome: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:736352. [PMID: 34621802 PMCID: PMC8491834 DOI: 10.3389/fcvm.2021.736352] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to identify the clinical features of Kawasaki disease shock syndrome (KDSS) in children. Methods: The case-control studies of KDSS and KD children up until April 30, 2021 were searched in multiple databases. The qualified research were retrieved by manually reviewing the references. Review Manager 5.3 software was used for statistical analysis. Results: The results showed that there was no significant difference in the incidence of male and female in children with KDSS. Children with KDSS compared with non-shocked KD, there were significant difference in age, duration of fever, white blood cell (WBC) count, percentage of neutrophils (NEUT%), platelet count (PLT), c-reactive protein level (CRP), alanine transaminase concentration (ALT), aspartate transaminase concentration (AST), albumin concentration (ALB), sodium concentration (Na), ejection fraction, and length of hospitalization as well as the incidence of coronary artery dilation, coronary artery aneurysm, left ventricular dysfunction, mitral regurgitation, pericardial effusion, initial diagnosis of KD, intravenous immunoglobulin (IVIG) resistance and receiving second dose of IVIG, vasoactive drugs, hormones, and albumin. In contrast, there was no difference in the hemoglobin concentration, erythrocyte sedimentation rate, and the incidence of conjunctival injection, oropharyngeal change, polymorphous rash, extremity change, and incomplete KD. Conclusion: Current evidence suggested that the children with KDSS had more severe indicators of inflammation and more cardiac abnormalities. These patients were resistant to immunoglobulin treatment and required extra anti-inflammatory treatment. Systematic Review Registration: PROSPERO registration number CRD42021241207.
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Affiliation(s)
- Zhimin Zheng
- College of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Yanzhi Huang
- Jilin Children's Medical Center, Children's Hospital of Changchun, Changchun, China
| | - Zhiyi Wang
- College of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Jia Tang
- College of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Xiaoqian Chen
- College of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Ying Li
- College of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Meng Li
- College of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Chengye Zang
- College of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Yibo Wang
- Jilin Children's Medical Center, Children's Hospital of Changchun, Changchun, China
| | - Liwu Wang
- Jilin Children's Medical Center, Children's Hospital of Changchun, Changchun, China
| | - Yingwei Ma
- Jilin Children's Medical Center, Children's Hospital of Changchun, Changchun, China
| | - Liwei Sun
- Jilin Children's Medical Center, Children's Hospital of Changchun, Changchun, China
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6
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Kawasaki Disease Shock Syndrome vs Classical Kawasaki Disease: A Meta-analysis and Comparison With SARS-CoV-2 Multisystem Inflammatory Syndrome. Can J Cardiol 2021; 37:1619-1628. [PMID: 34090979 PMCID: PMC8180353 DOI: 10.1016/j.cjca.2021.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The emergence of increasing reports worldwide of a severe inflammatory process and shock in pediatric patients resembling Kawasaki disease (KD)-and, more specifically, Kawasaki disease shock syndrome (KDSS)-prompted us to explore KDSS in a preamble of a systematic comparison between the 2 conditions. METHODS We completed a systematic review of KDSS and performed a meta-analysis comparison between reported KDSS cases and KD controls. RESULTS A total of 10 case-control series were included in the meta-analysis. Patients with KDSS were older (38.4 ± 30.6 vs 21.9 ± 19.5 months; P < 0.001) compared with standard KD with equal sex distribution and completeness of clinical diagnostic criteria. KDSS present higher C-reactive protein (59.4 ± 29.2 mg/dL vs 20.8 ± 14.8 mg/dL; P < 0.001), lower albumin (2.7 ± 0.5 g/dL vs 3.3 ± 0.5 g/dL; P < 0.01), and lower platelets (255 ± 149 109/L vs 394 ± 132 109/L; P < 0.001) but only borderline higher white blood cells (P = 0.06). Differences in alanine transaminase, aspartate aminotransferase, and erythrocyte sedimentation rate were nonsignificant. The odds of intravenous immunoglobulin resistance (44.4% vs 9.6%; (P < 0.001) and the hospital length of stay (10.9 ± 5.8 vs 5.0 ± 3.0 days; P < 0.001) were higher in KDSS, as were the odds of coronary-artery abnormalities (33.9% vs 8.6%; P < 0.001). CONCLUSIONS This first meta-analysis on KDSS vs KD represents a basis for future works on KDSS and opens the opportunity for future multicentre studies in the search of causal relationships between presenting elements and the eventual complications of KDSS. The similarities between SARS-CoV-2 multisystem inflammatory syndrome in children and KDSS open new horizons to the understanding of the etiology and pathophysiology related to KDSS.
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7
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Fukui S, Seki M, Minami T, Kotani K, Oka K, Yokomizo A, Matsubara D, Sato T, Nozaki Y, Saito M, Kikuchi Y, Miyamoto K, Monden Y, Yamagata T. Efficacy and safety associated with the infusion speed of intravenous immunoglobulin for the treatment of Kawasaki disease: a randomized controlled trial. Pediatr Rheumatol Online J 2021; 19:107. [PMID: 34217297 PMCID: PMC8254926 DOI: 10.1186/s12969-021-00601-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High-dose intravenous immunoglobulin (IVIG) is the mainstay of treatment for Kawasaki disease (KD). Usually, 2 g/kg of IVIG is administered over 10-24 h, depending on the institution or physician, but the association between infusion speed and effectiveness has not been reported. In this study, we evaluated the differences in efficacy and safety between two different IVIG administration speeds. METHODS This was a multicenter, unblinded, randomized controlled study. Patients newly diagnosed with KD were randomized into two groups: one who received IVIG over 12 h (12H group, double speed), and one that received IVIG over 24 h (24H group, reference speed). The endpoints included the duration of fever, incidence of coronary artery abnormalities (CAAs) and of adverse events. Laboratory data were evaluated before and after IVIG administration. RESULTS A total of 39 patients were enrolled. There was no difference between groups in fever duration after the initiation of IVIG (21 h vs. 21.5 h, p = 0.325), and no patient experienced CAAs. Two adverse events were observed in the 12H group (elevation of aspartate aminotransferase and vomiting), however no severe adverse events requiring treatments or extension of hospital stay were observed in either group. After initial IVIG administration, the change ratio of inflammatory markers, such as white blood cell counts, neutrophils, C-reactive protein, and albumin, did not show significant differences between the two groups. On the other hand, a greater increase of serum immunoglobulin G from its baseline level was observed in the 24H group compared to the 12H group (3037 ± 648 mg/dl vs. 2414 ± 248 mg/dl, p < 0.01). CONCLUSION The efficacy and safety of IVIG administered over 12 h (double speed) were similar to those administered over 24 h (reference speed). TRIAL REGISTRATION University Hospital Medical Information Network ( UMIN000014665 ). Registered 27 July 2014 - Prospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000017058.
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Affiliation(s)
- Saori Fukui
- grid.410804.90000000123090000Department of Pediatrics, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan ,Department of Pediatrics, Shin-Oyama City Hospital, Tochigi, Japan
| | - Mitsuru Seki
- Department of Pediatrics, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Takaomi Minami
- grid.410804.90000000123090000Department of Pediatrics, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Kazuhiko Kotani
- grid.410804.90000000123090000Division of Community and Family Medicine, Jichi Medical University, Tochigi, Japan
| | - Kensuke Oka
- grid.410804.90000000123090000Department of Pediatrics, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Akiko Yokomizo
- grid.410804.90000000123090000Department of Pediatrics, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Daisuke Matsubara
- grid.410804.90000000123090000Department of Pediatrics, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Tomoyuki Sato
- grid.410804.90000000123090000Department of Pediatrics, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Yasuyuki Nozaki
- Department of Pediatrics, Shin-Oyama City Hospital, Tochigi, Japan
| | - Mari Saito
- Department of Pediatrics, Haga Red-Cross Hospital, Tochigi, Japan
| | - Yutaka Kikuchi
- Department of Pediatrics, Haga Red-Cross Hospital, Tochigi, Japan
| | - Kenji Miyamoto
- grid.255137.70000 0001 0702 8004Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
| | - Yukifumi Monden
- grid.410804.90000000123090000Department of Pediatrics, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan ,grid.411731.10000 0004 0531 3030Department of Pediatrics, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Takanori Yamagata
- grid.410804.90000000123090000Department of Pediatrics, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
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8
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Multisystem inflammatory syndrome in children associated with novel coronavirus SARS-CoV-2: Presentations to a pediatric emergency department in Michigan. Am J Emerg Med 2020; 39:164-167. [PMID: 33131972 PMCID: PMC7585495 DOI: 10.1016/j.ajem.2020.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 12/20/2022] Open
Abstract
The SARS-CoV-2 is a respiratory virus of the coronavirus family responsible for a global pandemic since December 2019. More than 35 million people have been affected with the novel coronavirus disease (COVID-19), with more than one million deaths worldwide. Michigan was one of the top three states in the United States that was severely affected by the SAR-CoV-2 pandemic with more than 7000 deaths in adults and greater than 145,000 confirmed infections. However, compared to adults, the majority of children until recently were either asymptomatic or had a mild illness with SARS-CoV-2. Recently, a rare but potentially serious presentation associated with SARS-CoV-2 called multisystem inflammatory syndrome in children (MIS-C) has been recently reported and the Centers for Disease Control (CDC) released a case definition for the same. We report the clinical and laboratory presentations and outcomes of 34 children with MIS-C who were evaluated within a 12 week period at a pediatric emergency department (PED) of single institution in Michigan. These cases presented approximately three weeks after the peak of adult SAR-CoV-2 related deaths occurred in the state. While many children presented with clinical characteristics similar to incomplete Kawasaki disease (KD), they also exhibited certain unique features which differentiated MIS-C from KD. The information presented below will aid clinicians with early recognition, evaluation and management of MIS-C in the emergency department.
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9
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Capone CA, Subramony A, Sweberg T, Schneider J, Shah S, Rubin L, Schleien C, Epstein S, Johnson JC, Kessel A, Misra N, Mitchell E, Palumbo N, Rajan S, Rocker J, Williamson K, Davidson KW. Characteristics, Cardiac Involvement, and Outcomes of Multisystem Inflammatory Syndrome of Childhood Associated with severe acute respiratory syndrome coronavirus 2 Infection. J Pediatr 2020; 224:141-145. [PMID: 32553873 PMCID: PMC7293762 DOI: 10.1016/j.jpeds.2020.06.044] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
We report on the presentation and course of 33 children with multisystem inflammatory syndrome in children and confirmed severe acute respiratory syndrome coronavirus 2 infection. Hemodynamic instability and cardiac dysfunction were prominent findings, with most patients exhibiting rapid resolution following anti-inflammatory therapy.
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Affiliation(s)
- Christine A. Capone
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Anupama Subramony
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Todd Sweberg
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - James Schneider
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Sareen Shah
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Lorry Rubin
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Charles Schleien
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY; Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY.
| | | | - Shilpi Epstein
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Jennifer C. Johnson
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY
| | - Aaron Kessel
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Nila Misra
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Elizabeth Mitchell
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Nancy Palumbo
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Sujatha Rajan
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Josh Rocker
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Kristy Williamson
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Karina W. Davidson
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY,Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY
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10
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Faraji E, Sukumaran S, Vijayan V. A 3 Year Old With Fever and Rash: An Atypical Cause of Shock. Clin Pediatr (Phila) 2020; 59:740-742. [PMID: 32028793 DOI: 10.1177/0009922820903514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ehssan Faraji
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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11
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Chiotos K, Bassiri H, Behrens EM, Blatz AM, Chang J, Diorio C, Fitzgerald JC, Topjian A, John ARO. Multisystem Inflammatory Syndrome in Children During the Coronavirus 2019 Pandemic: A Case Series. J Pediatric Infect Dis Soc 2020; 9:393-398. [PMID: 32463092 PMCID: PMC7313950 DOI: 10.1093/jpids/piaa069] [Citation(s) in RCA: 261] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022]
Abstract
We present a series of 6 critically ill children with multisystem inflammatory syndrome in children. Key findings of this syndrome include fever, diarrhea, shock, and variable presence of rash, conjunctivitis, extremity edema, and mucous membrane changes.
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Affiliation(s)
- Kathleen Chiotos
- Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Correspondence: Kathleen Chiotos, Roberts Center for Pediatric Research, 2716 South Street, Room 10292, Philadelphia, PA 19146 ()
| | - Hamid Bassiri
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward M Behrens
- Division of Rheumatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Allison M Blatz
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joyce Chang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Division of Rheumatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Caroline Diorio
- Division of Hematology and Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julie C Fitzgerald
- Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexis Topjian
- Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Audrey R Odom John
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Abstract
BACKGROUND Platelet count is considered as a biomarker for the development of coronary artery abnormalities (CAAs) among Kawasaki disease (KD) patients. However, previous studies have reported inconsistent results. We addressed the controversial association of platelet count with CAAs using a large-scale dataset. METHODS A retrospective cohort study was conducted using KD survey data from Japan (2015-2016; n = 25,448). Classifying patients by intravenous immunoglobulin (IVIG) responsiveness, we described the trends in platelet count using the lowest and highest values along with the specific illness days. Multivariate logistic regression analysis was performed to evaluate the association between platelet count and CAAs, adjusting for relevant factors. RESULTS Platelet counts rapidly decreased from admission, reached the lowest count at 6-7 days, and peaked after 10 days. Platelet counts in IVIG non-responders decreased with a lower minimum value than IVIG responders, but subsequently rebounded toward a higher maximum. Compared with patients with normal platelet counts (150-450 × 10/L), patients with abnormally high platelet counts (>450 × 10/L) were more likely to have CAAs at admission (adjusted odds ratio: IVIG responders, 1.50 [95% confidence interval 1.20-1.87] and non-responders, 1.46 [1.01-2.12]). By contrast, IVIG non-responding patients whose counts were below normal (<150 × 10/L) after hospitalization were at higher risk for developing CAAs (2.27 [1.44-3.58]). CONCLUSIONS Platelet count varied widely by illness day and was confounded by IVIG responsiveness, which might have contributed to previous inconsistent findings. KD patients with abnormally high platelet counts at admission or abnormally low counts after hospitalization were at higher risk for CAAs.
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13
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Pilania RK, Jindal AK, Bhattarai D, Naganur SH, Singh S. Cardiovascular Involvement in Kawasaki Disease Is Much More Than Mere Coronary Arteritis. Front Pediatr 2020; 8:526969. [PMID: 33072669 PMCID: PMC7542237 DOI: 10.3389/fped.2020.526969] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
Kawasaki disease (KD) is now a common cause of acquired heart disease in children. Coronary artery involvement is the most serious complication in children with KD. Several non-coronary complications have now been identified in this condition but these are often overlooked. Myocarditis is an integral component of KD and may be more common than coronary artery abnormalities. Pericardial involvement and valvular abnormalities have also been observed in patients with KD. KD shock syndrome is now being increasingly recognized and may be difficult to differentiate clinically from toxic shock syndrome. Endothelial dysfunction has been reported both during acute stage and also on follow-up. This may be a potentially modifiable cardiovascular risk factor.
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Affiliation(s)
- Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dharmagat Bhattarai
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Hanumantacharya Naganur
- Department of Cardiology, Advances Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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14
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Hashimoto I. Indicators of unresponsiveness after initial i.v. immunoglobulin treatment in acute Kawasaki disease. Pediatr Int 2019; 61:641-646. [PMID: 31132210 DOI: 10.1111/ped.13898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 04/10/2019] [Accepted: 05/24/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to identify the indicators of unresponsiveness to initial i.v. immunoglobulin (IVIG) treatment for Kawasaki disease (KD). METHODS One hundred and forty-five patients with KD, who had received initial treatment consisting of a single IVIG dose (1 g/kg or 2 g/kg) and oral aspirin (30 mg/kg), were studied. Laboratory parameters, including C-reactive protein (CRP) and serum sodium (Na), were measured before and after IVIG treatment, and during the convalescent phase, and the laboratory data compared with regards to IVIG response. Multiple logistic regression models, which included laboratory data obtained immediately after the IVIG treatment, were constructed to determine the indicators of IVIG unresponsiveness immediately after the completion of the initial treatment. RESULTS On logistic regression analysis, serum Na after IVIG treatment was the only independent factor related to initial IVIG unresponsiveness (β = 0.53, P < 0.01; OR, 1.69; 95%CI: 1.15-2.49). On receiver operating characteristic curve analysis, the optimal serum Na cut-off immediately after IVIG treatment was 135.5 mEq/L with a sensitivity of 0.75, and a specificity of 0.79. CONCLUSIONS Prolonged hyponatremia after completion of the initial IVIG therapy was an indicator of the need for subsequent IVIG therapy. Treatment plans should be established for patients with acute KD that pay particular attention to prolonged hyponatremia.
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Affiliation(s)
- Ikuo Hashimoto
- Department of Pediatrics, Toyama City Hospital, Toyama City, Toyama, Japan
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15
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Zhang Q, Liao Y, Du J. Kawasaki disease shock syndrome: A report of two cases and literature review. Pediatr Investig 2019; 3:81-85. [PMID: 32851296 PMCID: PMC7331343 DOI: 10.1002/ped4.12127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/26/2019] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Kawasaki disease shock syndrome (KDSS) is a rare Kawasaki disease (KD) manifestation. The pediatricians are not aware of the full range of clinical characteristics of KDSS. OBJECTIVE We aimed to investigate the clinical features, diagnosis and treatment of KDSS in two patients and we included a literature review. METHODS We collected and analyzed the clinical data for two patients with KDSS. Additionally, using "Kawasaki diseases shock syndrome" as a key phrase, we searched PubMed, Biotechnology Information and Wanfang Data Knowledge Service Platform databases for any similar reports between January 2009 and March 2017. RESULTS Both of our patients diagnosed with KD developed sustained hypotension during the course of intravenous immunoglobulin treatment, as well as hypoalbuminemia, and increased C-reactive protein and brain natriuretic peptide levels during hypotension. Both patients responded well to fluid resuscitation and inotropic support. No aneurysms formed in either patient during follow-up. We reviewed two related studies in Chinese and 11 studies in English. INTERPRETATION KD may present with severe shock, and requires proper diagnosis and rapid treatment. The prognosis for most patients with KDSS is excellent.
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Affiliation(s)
- Qingyou Zhang
- Department of PediatricsPeking University First HospitalBeijingChina
| | - Ying Liao
- Department of PediatricsPeking University First HospitalBeijingChina
| | - Junbao Du
- Department of PediatricsPeking University First HospitalBeijingChina
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16
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Abstract
OBJECTIVE This study was performed to explore the clinical features of Kawasaki disease shock syndrome and analyse the association between the left ventricular ejection fraction and Kawasaki disease shock syndrome. METHODS We retrospectively reviewed the medical records of all consecutive inpatients with Kawasaki disease at Wenzhou Medical University Second Affiliated Hospital and Yuying Children's Hospital in Wenzhou, China from January 2009 to December 2016. We compared the clinical characteristics, laboratory data, and left ventricular ejection fraction between patients with and without Kawasaki disease shock syndrome and analysed the effect of the left ventricular ejection fraction on Kawasaki disease shock syndrome under different clinical conditions of Kawasaki disease. RESULTS In total, 1147 patients were diagnosed with Kawasaki disease. Of these 1147 patients, 17 were diagnosed with Kawasaki disease shock syndrome; 68 patients admitted to the hospital at the same time, ±2 weeks, with Kawasaki disease but without Kawasaki disease shock syndrome served as the control group. Compared with the control group, the Kawasaki disease shock syndrome group had a significantly higher incidence of coronary artery lesions, cardiac troponin I concentration, N-terminal prohormone of brain natriuretic peptide concentration, neutrophil count and ratio, alanine aminotransferase concentration, aspartate aminotransferase concentration, and C-reactive protein concentration and a significantly lower platelet count, serum albumin concentration, and left ventricular ejection fraction. A low left ventricular ejection fraction was associated with Kawasaki disease shock syndrome under different conditions of Kawasaki disease. CONCLUSION Among patients with Kawasaki disease, cardiac injury is more likely in those with Kawasaki disease shock syndrome than without, and a low left ventricular ejection fraction may be associated with the development of Kawasaki disease shock syndrome.
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17
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Zhang H, Xie L, Xiao T. Extracorporeal Membrane Oxygenation Support for Cardiac Dysfunction Due to Kawasaki Disease Shock Syndrome. Front Pediatr 2019; 7:221. [PMID: 31245335 PMCID: PMC6563758 DOI: 10.3389/fped.2019.00221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/16/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Kawasaki disease (KD) is usually characterized as an inflammatory vasculitis during early childhood, which predominantly involves medium-sized arteries and is treated with intravenous γ-globulin (IVIG) and oral aspirin. KD with hemodynamic instability, characterized by systolic blood pressure decreasing by more than 20% below the normal range, is defined as Kawasaki disease shock syndrome (KDSS). The pathogenesis of KDSS is still not comprehensively understood. Life-threatening cardiogenic shock can occur during the acute phase of KDSS, while the mechanism of cardiac dysfunction due to KDSS is still controversial, and such cases are rarely reported. Here, we present the application of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) for cardiac function support of a child with KDSS. By doing so, it will be a reminder that KDSS can cause severe cardiac dysfunction, and we should stay vigilant at the early stage of the disease to distinguish KDSS from toxic septic shock in the first place and initiate the appropriate treatment at the right moment, in order to prevent such patients from having irreversible outcomes.
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Affiliation(s)
- Han Zhang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Lijian Xie
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Tingting Xiao
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
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