Clinical Characteristics,Risk Factors And Predictors Of Kawasaki Disease Shock Syndrome In Children

Objective:To investigate the clinical features of Kawasaki disease shock syndrome（KDSS）in children,compare the clinical,laboratory and imaging indexes of Kawasaki disease（KD）children with and without shock,and analyze the possible risk factors and predictive values.Methods:29 patients with KDSS（KDSS group）and 51 Kawasaki disease patients（control group）in the same period（2 weeks before and after admission）with stable hemodynamics from the Children’s hospital affiliated to Chongqing Medical University between May 2013 to October2020 were enrolled in the study.The demography,clinical features,laboratory and imaging examinations,treatment,prognosis and follow-up of all the patients were observed and compared between the two groups.Multivariate logistic regression was used to analyze the possible risk factors.Receiver operating characteristic curve（ROC curve）was used to analyze the predictive value of risk factors for shock in KD.Results:There were 29 children in KDSS group,including 16 males and 13 females,with an average age was 49.0 months（range:3 to 128months）.There were significant differences in hemoglobin（Hb）,neutrophil percentage,alanine aminotransferase（ALT）,albumin（Alb）,high-sensitivity troponin I（Tn I）and procalcitonin（PCT）levels before and after shock（P<0.05）.Compared with KD group,the age of the two groups was statistically significant（P<0.05）.There was no significant difference in gender,ratio of incomplete Kawasaki disease（IKD）,fever peak,fever time in hospital,five main clinical manifestations of KD and fever course at diagnosis between the two groups（P>0.05）.The levels of neutrophil count,percentage of neutrophils,mean platelet volume（MPV）,platelet distribution width（PDW）,large platelet ratio（LPCR）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,blood urea nitrogen（Ur）,serum creatinine（Cr）,high-sensitivity troponin I（Tn I）,B-type natriuretic peptide（BNP）,D-dimer,C-reactive protein and procalcitonin（PCT）of KDSS were higher than the control group,while the levels of platelet（PLT）,thrombocytocrit,Alb,total protein（TP）,sodium（Na）,potassium（K）and phosphorus（P）of KDSS group were lower than control group（P<0.05）.In KDSS group,26 cases（89.3%,26/29）were treated with albumin,and 16 cases（55.2%,16/29）were treated with vasoactive drugs and（or）cardiotonics.Compared with the control group,the total fever course and hospital stay of KDSS group were longer,the proportion of the second IVIG and hormone were higher,the incidence of cardiovascular abnormalities in acute phase was higher,and the proportion of multiple organ dysfunction was higher（P<0.05）.8 cases（27.6%,8/29）were treated in intensive care unit,2 cases（6.9%,2/29）were treated with ventilator,2 cases（6.9%,2/29）were treated with plasma exchange,and 1case（3.4%,1/29）was treated with hemodialysis and hemofiltration.Multivariate logistic regression analysis showed that MPV（OR=13.001,95%CI:1.887～89.568,regression coefficient 2.565,Wald=6.785,P<0.01）,Alb（OR=0.514,95%CI:0.314～0.842,regression coefficient-0.665,Wald=6.990,P<0.01）were risk factors for shock in children with KD.ROC curve analysis results showed that the area under the curve（AUC）of Alb combine with MPV in predicting the shock in KD was 0.989（95%CI:0.973-1.000）,sensitivity of 93.1%and specificity of 98.0%.The sensitivity and specificity were 82.8%and 90.2%when ALB was 32.2g·L^-1,and96.6%and 64.7%when MPV was 9.85f L,respectively.Conclusion:Children with KDSS have more severe inflammatory reaction,more cardiovascular system involvement and more multiple organ system involvement,which need timely diagnosis and treatment by clinicians.Alb and MPV have predictive value for the occurrence of shock in KD,and their combined predictive value is greater.When Alb is lower than 32.2g·L-1,and MPV is higher than 9.85fl,shock is more likely to occur in KD.