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

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