Clinical manifestations of 16 cases with Kawasaki disease shock syndrome / 中国小儿急救医学

ABSTRACT

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.