Assessment indicators for discontinuing treatment of low dose aspirin in children with Kawasaki disease

Abstract

Objective To investigate the effect of discontinuing low dose aspirin treatment on the efficacy and prognosis of Kawasaki disease based on normalization time of inflammation indexes and thrombus markers, and echocardiography results. Methods From June 2013 to December 2017, a total of 82 children with Kawasaki disease who were hospitalized at the Children′s Hospital of Capital Institute of Pediatrics were chosen as research objects. According to the type of Kawasaki disease, 82 children were divided into complete Kawasaki disease (CKD) group (n=48) and incomplete Kawasaki disease (IKD) group (n=34). In addition, 82 children were also divided into coronary artery lesion (CAL) group (n=9) and none CAL group (n=73) according to whether complicated with CAL of the results of echocardiography at discharge from hospital. Low dose aspirin with 3-5 mg/(kg·d) by oral were given to all patients at the time point of 72 h of normal body temperature after acute phase treatment. During 8 weeks of follow up period after discharge from hospital, the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of inflammation indexes, as well as platelet and D-dimer levels of thrombus markers were monitored; when all these four indicators were normalized and CAL were not found by echocardiography, low dose aspirin were discontinued and still continued follow up until 8 weeks after discharge. Statistical analysis was performed on the following measurement and numeration data using t test, Wilcoxon rank sum test and chi-square test. ① Clinical data at admission, as well as normalization time of inflammatory indexes and thrombus markers after treatment between CKD group and IKD group, also between CAL group and none CAL group of children. ② Normalization time of inflammatory indexes of 82 cases of Kawasaki disease children among different conditions. This study was in line with World Medical Association Declaration of Helsinki revised in 2013. Results ① Comparison of serum CRP and D-dimer levels in children with Kawasaki disease at admission: CRP and D-dimer levels were (10.2±4.9) mg/L and (1.1±0.3) mg/L, respectively in CKD group, which were higher than IKD group′s (7.4±3.9) mg/L and (0.9±0.5) mg/L; and those two indexes in CAL group were (13.9±7.6) mg/L and (1.7±1.5) mg/L, respectively, which were higher than none CAL group′s (8.5±3.9) mg/L and (1.0±0.7) mg/L, and all the differences above were statistically significant (t=2.638, P=0.007; t=2.716, P=0.027; t=3.402, P=0.001; t=0.382, P=0.017). Comparison of serum albumin levels in children with Kawasaki disease at admission: serum albumin level was (35.5±4.3) g/L in CKD group, which was lower than IKD group′s (37.5±3.6) g/L; and this index was (32.3±3.5) g/L in CAL group, which was lower than none CAL group′s (36.4±3.8) g/L, and the differences were statistically significant (t=2.324, P=0.016; t=4.170, P 0.05). ③The normalization times of inflammatory indexes and thrombus markers in 82 children with Kawasaki disease after treatment were (44.2±9.4) d of ESR, (14.4±5.5) d of CRP, (31.5±10.9) d of blood platelet count and (33.5±6.3) d of D-dimer level. ④The normalization time of ESR and CRP in male children with Kawasaki disease of this study were (46.3±5.2) d and (16.4±5.6) d, respectively, which were longer than female children′s (43.4±5.0) d and (13.3±4.8) d, and the differences were statistically significant (t=2.106, P=0.012; t=2.308, P=0.010). There were no significant differences under the condition between the persistent of fever ≥7 d and 0.05). ⑤One CKD child complicated with CAL and the other 73 children without CAL at the time of discharge had normalized levels of inflammatory indexes and thrombus markers after 3-4 weeks of discharge, also no CAL by echocardiography. Therefore, low dose aspirin treatment was discontinued for these children, and no new CAL occurred during the follow up period. Conclusions By monitoring the levels of inflammatory indexes and thrombus markers, and with echocardiography, low dose aspirin treatment after acute phase of Kawasaki disease can be adjusted individually without affecting clinical efficacy and prognosis. Key words: Mucocutaneous lymph node syndrome; Aspirin; Blood sedimentation; C-reactive protein; Thrombosis; Echocardiography; Child