Clinical characteristics of Kawasaki disease shock syndrome in children and its related factors

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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) patients. 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 cases) 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 admission.Ten cases (90.9%, 10/11 cases) showed abnormal echocardiography (coronary artery dilation and mitral regurgitation 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 gastrointestinal 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±1 411.48) 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 echocardiography 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. Key words: Kawasaki disease; Shock; Hypotension; Kawasaki disease shock syndrome; Child; Related factors; Gastrointestinal involvement