Clinical Features in Children With Kawasaki Disease Shock Syndrome: A Systematic Review and Meta-Analysis

Zhimin Zheng,Liwei Sun,Yibo Wang,Yingwei Ma,Meng Li,Liwu Wang,Ying Li,Yanzhi Huang,Zhiyi Wang,Xiaoqian Chen,Chengye Zang,Jia Tang

doi:10.3389/fcvm.2021.736352

Abstract

Objective: This study aimed to identify the clinical features of Kawasaki disease shock syndrome (KDSS) in children.Methods: The case-control studies of KDSS and KD children up until April 30, 2021 were searched in multiple databases. The qualified research were retrieved by manually reviewing the references. Review Manager 5.3 software was used for statistical analysis.Results: The results showed that there was no significant difference in the incidence of male and female in children with KDSS. Children with KDSS compared with non-shocked KD, there were significant difference in age, duration of fever, white blood cell (WBC) count, percentage of neutrophils (NEUT%), platelet count (PLT), c-reactive protein level (CRP), alanine transaminase concentration (ALT), aspartate transaminase concentration (AST), albumin concentration (ALB), sodium concentration (Na), ejection fraction, and length of hospitalization as well as the incidence of coronary artery dilation, coronary artery aneurysm, left ventricular dysfunction, mitral regurgitation, pericardial effusion, initial diagnosis of KD, intravenous immunoglobulin (IVIG) resistance and receiving second dose of IVIG, vasoactive drugs, hormones, and albumin. In contrast, there was no difference in the hemoglobin concentration, erythrocyte sedimentation rate, and the incidence of conjunctival injection, oropharyngeal change, polymorphous rash, extremity change, and incomplete KD.Conclusion: Current evidence suggested that the children with KDSS had more severe indicators of inflammation and more cardiac abnormalities. These patients were resistant to immunoglobulin treatment and required extra anti-inflammatory treatment.Systematic Review Registration: PROSPERO registration number CRD42021241207.

Highlights

Kawasaki disease (KD) is an acute immune systemic smallto medium-sized vasculitis characterized by fever, cervical lymphadenopathy, conjunctival injection, oropharyngeal changes, polymorphous rash, and extremity changes
This study aimed to identify the clinical features of Kawasaki disease shock syndrome (KDSS) in children
The results showed that there was no significant difference in the incidence of male and female in children with KDSS

Summary

Introduction

Kawasaki disease (KD) is an acute immune systemic smallto medium-sized vasculitis characterized by fever, cervical lymphadenopathy, conjunctival injection, oropharyngeal changes, polymorphous rash, and extremity changes. Children with KD have developed serious complications, such as shock and heart failure, and Kanegaye et al [2] defined this hemodynamically unstable KD as Kawasaki disease shock syndrome (KDSS), with the specific criteria of the presence of a systolic blood pressure consistently below 20% of the mean systolic blood pressure in normal children of the same age, or signs of impaired perfusion in the peripheral circulation. Most of the studies in KDSS in China and abroad are case reports or the retrospective clinical analyses of small samples, and the descriptions of its clinical features vary from one another. There is a lack of a large sample and multicenter study of KDSS in mainland China, and the understanding of the clinical KDSS features is not sufficient. We had conducted an evidence-based analysis of controlled studies on the clinical characteristics of KDSS in children in the past 10 years, aiming at deepening the understanding of KDSS, summarizing the experience, and improving the clinical diagnosis and treatment activities

Methods

Results

Conclusion