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OBJECTIVES@#To study the role of plasma exchange combined with continuous blood purification in the treatment of refractory Kawasaki disease shock syndrome (KDSS).@*METHODS@#A total of 35 children with KDSS who were hospitalized in the Department of Pediatric Intensive Care Unit, Hunan Children's Hospital, from January 2019 to August 2022 were included as subjects. According to whether plasma exchange combined with continuous veno-venous hemofiltration dialysis was performed, they were divided into a purification group with 12 patients and a conventional group with 23 patients. The two groups were compared in terms of clinical data, laboratory markers, and prognosis.@*RESULTS@#Compared with the conventional group, the purification group had significantly shorter time to recovery from shock and length of hospital stay in the pediatric intensive care unit, as well as a significantly lower number of organs involved during the course of the disease (P<0.05). After treatment, the purification group had significant reductions in the levels of interleukin-6, tumor necrosis factor-α, heparin-binding protein, and brain natriuretic peptide (P<0.05), while the conventional group had significant increases in these indices after treatment (P<0.05). After treatment, the children in the purification group tended to have reductions in stroke volume variation, thoracic fluid content, and systemic vascular resistance and an increase in cardiac output over the time of treatment.@*CONCLUSIONS@#Plasma exchange combined with continuous veno-venous hemofiltration dialysis for the treatment of KDSS can alleviate inflammation, maintain fluid balance inside and outside blood vessels, and shorten the course of disease, the duration of shock and the length of hospital stay in the pediatric intensive care unit.
Subject(s)
Humans , Child , Plasma Exchange , Mucocutaneous Lymph Node Syndrome/therapy , Continuous Renal Replacement Therapy , Renal Dialysis , Plasmapheresis , ShockABSTRACT
Objective:Kawasaki disease shock syndrome(KDSS) is a serious complication of Kawasaki disease(KD). The main manifestations are low blood pressure and decreased blood perfusion at the acute stage of onset, which is life-threatening.The purpose of this study was to provide early intervention and reduce the complications and mortality of this disease by analyzing clinical features and expression level of interleukin-6(IL-6)of children with KDSS.Methods:In this study, a total of 25 children with KDSS in Nanjing Children′s Hospital were collected, and their clinical characteristics, relevant laboratory indicators and IL-6 expression levels were analyzed by retrospective case-control study.Results:Compared with ordinary KD children, KDSS children were more common in older children, with prolonged fever, severe skin rash, high inflammatory indicators, and more likely to be associated with coronary dilatation.The level of IL-6 in children with KDSS in the acute phase was significantly higher than that in children with KD[(28.5±39.2) ng/mL vs.(226.8±102.9) ng/mL, P<0.05], while the level of IL-6 in children with KDSS in the convalescent period was significantly lower than that in the acute phase of KDSS[(226.8±102.9) ng/mL vs.(5.6±1.7)ng/mL, P<0.05], and the difference was statistically significant. Conclusion:The systemic inflammatory response of KDSS is more obvious, IL-6 plays an important role in it, and the therapeutic effect of IL-6 blocker in KD and its complications needs further study.
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Kawasaki disease (KD) is an acute systemic small and medium vasculitis syndrome,which is most commonly found in children under the age of 5 years.The most severe complications of KD are coronary artery lesions (CAL),which will lead to coronary artery dilatation,myocardial infarction and sudden death.In the acute stage,severe clinical manifestations are associated with shock,and all organs could be involved,which is called severe Kawasaki disease (SKD),sometimes requiring treatment in the pediatric intensive care unit (PICU) have been reported.Although the clinical symptoms of children with SKD are severe,most patients can survive without any sequelae as long as they can be diagnosed accurately and treated rapidly.In recent years,scholars at home and abroad have paid more and more attention to SKD.Based on these,we take SKD as the research object,try to explain the progress of clinical diagnosis and treatment,which is beneficial to pediatric clinicians to accurately judge and treat related diseases.
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Kawasaki disease shock syndrome (KDSS) is a serious manifestation of Kawasaki disease. It is a clinical symptom of hypoperfusion, which occurs hemodynamic instability on the basis of the diagnosis of Kawasaki disease. KDSS can occur in the early stage of Kawasaki disease, and can be easily missed and misdiagnosed. Now, the clinical features, pathogenesis and treatment of KDSS are reviewed, in order to improve the ability of clinical pediatricians to identify the disease early and reduce the occurrence of life-threatening complications.
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Objective To investigate the clinical features of Kawasaki disease shock syndrome(KDSS)in children by comparing the clinical and laboratory characteristics with those of non-shock Kawasaki disease(KD)pa-tients. Methods Consecutive hospitalized patients diagnosed as KD were included,who had been admitted into the Children′s Hospital of Nanjing Medical University between January 1 and December 31,2015. There were 11 cases complicated with shock (KDSS group)and 61 cases without shock (non-shock KD group). The demographic,clinical and laboratory data were collected from all these 72 patients and comparisons were made between the KDSS group and the non-shock KD group. The parameters correlated with KDSS were evaluated by Logistic regression analysis. Results Of the 72 patients with KD,males accounted for 77. 8％ (56 / 72 cases),and 11 cases (15. 3％,11 / 72 ca-ses)met the diagnosis of KDSS. All the patients with KDSS received fluid resuscitation and vasoactive drug,and 2 cases (18. 2％,2 / 11 cases)showed resistance to intravenous immunoglobulin. There were 2 cases (18. 2％,2 / 11 cases)in the KDSS group and 10 cases (16. 4％,10 / 61 cases)in the non-shock KD group presented as incomplete KD on ad-mission. Ten cases (90. 9％,10 / 11 cases)showed abnormal echocardiography (coronary artery dilation and mitral re-gurgitation were mostly observed)in the KDSS group,otherwise 11 cases (18. 0％,11 / 61 cases)in the non-shock KD group,and there was a significant difference(P = 0. 000). Two cases (18. 2％,10 / 11 cases)had an acute gastrointesti-nal bleeding in the KDSS group,while none in the non-shock KD,and there was a significant difference(P = 0. 001). The patients with vomiting were significantly more in the KDSS group[54. 5％(6 / 11 cases)]than the non-shock KD group [16. 4％(10 / 61 cases)],and there was a significant difference(P = 0. 005). The significant differences in most laboratory indexes between the KDSS group and the non-shock KD group were as follows:(131. 91 ± 3. 86)mmol/ L vs. (136. 02 ± 4. 23)mmol/ L in sodium concentration (P = 0. 000),(834. 91 ± 1411. 48)ng/ L vs. (128. 28 ± 98. 92) ng/ L in B-type natriuretic peptide (P = 0. 000),(0. 72 ± 2. 19)μg/ L vs. (0. 00 ± 0. 01)μg/ L in troponin I (P =0. 010),(25. 44 ± 34. 06)μg/ L vs. (1. 18 ± 1. 97)μg/ L in procalcitonin (P = 0. 000). Also,immunological status of these patients with KDSS and non-shock KD varied as follows:(44. 39 ± 11. 86)％ vs. (59. 69 ± 10. 86)％ in CD3 + T lymphocytes (P = 0. 000),(25. 17 ± 8. 78)％ vs. (35. 77 ± 11. 24)％ in CD4 + T lymphocytes (P = 0. 005), (9. 93 ± 5. 63)％ vs. (5. 41 ± 0. 63)％ in natural killer(NK)cells (P = 0. 000),(40. 93 ± 13. 74)％ vs. (29. 18 ± 9. 53)％ in B cells (P = 0. 000). Logistic regression analysis showed that troponin I[odds ratio(OR)= 4. 173,Wald =56. 967,P < 0. 001],PCT(OR = 0. 378,Wald = 14. 738,P = 0. 007),and NK cells (OR = 0. 053,Wald = 6. 656,P =0. 008)were the factors associated with KDSS. Conclusions The abnormalities of gastrointestinal tract and echocardio-graphy in KDSS were significantly higher than those of the non-shock KD. Although multifactor analysis results just showed that troponin I,PCT,NK cells were associated with KDSS. If KD patients have hyponatremia,abnormal elevation of B-type natriuretic peptide and dysfunction of cellular immunity,KDSS might be considered.
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Objective To analyze the clinical characteristics of Kawasaki disease shock syndrome ( KDSS) and to improve the diagnosis,treatment and prognosis of patients. Methods A total of 924 cases of Kawasaki disease ( KD) hospitalized from January 2013 to April 2017 in our hospital were retrospectively an-alyzed,including 16 children with KDSS. And 30 patients with KD were randomly selected as the control group. The clinical characteristics,laboratory examination and treatment of the two groups were compared and analyzed. Results There were 9 males and 7 females in KDSS group,and average age was (3. 95 ± 2. 56) years. The average time to happen shock was (4. 31 ± 0. 79) days. There were no significant differences in gender,age and duration of fever between KDSS group and KD group respectively ( P >0. 05 ) . KDSS patients were more likely to develop abdominal pain, hepatic injury ( including elevated transaminase and jaundice),proteinuria,peritoneal effusion,pneumonia,coronary aneurysm,IVIG resistance and longer hospi-talization (P<0. 05). WBC[(28. 42 ± 10. 46) × 109/L vs. (20. 34 ± 7. 57) × 109/L],the neutrophils [(89.86 ± 7.00)％ vs. (73.14 ± 13.91)％],hsCRP (mg/L) [181.95(141.58,218.00) vs.94.65 (55. 33,109. 50)],PCT(ng/ml)[9. 68 (4. 85,12. 07) vs. 0. 09 (0. 04,0. 37)] and serum ferritin (ng/ml) [(388. 12 ± 241. 75) vs. (169. 86 ± 95. 14)] in the KDSS group was significantly higher than those in KD group (P<0. 05). There were no differences in ESR(mm/h) [(75. 71 ± 25. 25) vs. (79. 87 ± 22. 76)], fibrinogen (g/L) [(6. 17 ± 1. 45) vs. (6. 03 ± 1. 47)] between two groups (P>0. 05). The levels of plate-let count[ (655. 50 ± 226. 98) × 109/L vs. (549. 93 ± 119. 15) × 109/L],the albumin (g/L) [(22. 54 ±5.13)vs.(33.32±3.18)],serumsodium(mmol/L)[(130.47±2.79)vs.(134.77±2.81)]andserumpotassi-um (mmol/L) [(4. 59 ± 0. 74) vs. (4. 04 ± 0. 43)] and ejection fraction [(60. 16 ± 6. 18)％ vs. (64. 81 ± 3. 71)％] in KDSS group were lower than those in KD group (P<0. 05). During the course of treatment,14 patients were accepted fluid resuscitation and the average volume of fluid was (27. 19 ± 19. 58) ml/kg. Ten patients used vasoactive drugs. Six patients were treated with hormone ( methylprednisolone ) . All patients were discharged from hospital. Conclusion KDSS is a serious form of KD,the indicators of inflammatory response increased more obviously. Organ damage occurs more frequently,and often accompanies abdominal pain. Anti-shock treatment often requires fluid resuscitation and use of vasoactive drugs.