The clinical features of children with Kawasaki disease in PICU / 中国小儿急救医学

ABSTRACT

Objective To summarize the clinical characteristics of children with Kawasaki disease (KD) in pediatric intensive care unit(PICU). Methods Medical record of children with KD at PICU were collected. At the same time,29 cases of KD in PICU were 1∶3 matched by age,gender and the time admitted in hospital with those admitted in general pediatric department(control group). Results PICU patients had longer length of hospital stay,longer fever duration compared with control group. In addition,patients in PICU had higher neutrophil percentage,C reaction protein,creatinine,urea nitrogen,N￣terminal natriuretic peptide and procalcitonin,but lower hemoglobin,blood platelet and albumin compared with the control group. What′s more,patients in PICU tended to find hemoglobin<100 g/L,platelet<150×109/L,albumin<30 g/L,abnor￣mal in urine routine and echocardiographic and more likely to have fever longer than 10 days when used intra￣venous immunoglobulin(IVIG) compared with control group. And PICU patients were more likely to require therapy with antibiotics,albumin,glucocorticoid and the second dose of IVIG. Some part of children in PICU group were treated with IVIG and glucocorticoid because of doubted severe infection before KD diagnosed,all patients in the control group used IVIG after the diagnosis. Conclusion Patients who admitted in PICU are severe and not typical in clinical manifestation. These patients are easily misdiagnosed as sepsis and more likely to be IVIG￣refractory and have coronary artery damage. We still worry that somebody might be misdi￣agnosed as sepsis,who are treated with IVIG and get better. Because they are not diagnosed as KD,these pa￣tient would not followe up like KD,but have potential risk of cardiovascular disease and need more alarming.