The Clinical Significance Of Laboratory Indice Recommended By The American Heart Association In The Diagnosis Of Imcomplete Kawasaki Disease

Background and purposeKawasaki disease (KD) is a systemic vasculitis that mainly affects children younger than5years. Although Dr. Kawasaki first reported KD over40years ago, the cause of the disease remains unknown. Currently, KD has been diagnosed in more than60countries. Kawasaki disease is a leading cause of acquired heart disease in developed countries.With unknown cause and no diagnostic test or pathognomonic clinical finding, KD has been diagnosed by using a clinical case definition that requires fever together with4of5principal clinical criteria. However, children with incomplete KD (thosewho do not meet the complete clinical case definition) seem to have a risk of CAAs at least as great as that of children who fulfill the classic criteria.Timely diagnosis and treatment of children with incomplete KD remain challenging. In2004, the American Heart Association (AHA) published a statement on the diagnosis, treatment, and longterm management of KD, which subsequently was endorsed by the American Academy of Pediatrics. The report included an algorithm to aid clinicians inthe evaluation of patients with suspected KD who do not meet the complete case definition and thus may not be identified or receive timely IVIG treatment. Laboratory tests, even though they are nonspecific, can provide diagnostic support in patients with clinical features that are suggestive but not diagnostic of Kawasaki disease. The AHA algorithm for patients with suspected incomplete KD(iKD) was based on expert opinionand anecdotal reports, rather than large clinical trials or registries. ESR, CRP, PLT,and WBC, ect,eight laboratory indince were supplemental in AHA algorithm to help iKD diagnosis, but so far, the research on clinical significance of8laboratory indice recommended by the AHA in the diagnosis of iKD is little. This research hope to review KD patients of zhengzhou university through third affiliated hospital during5years, compare the clinical characteristics of patients with cKD and iKD; compare the eight supplemental laboratory indice suggested by the AHA between the iKD group and the sepisis group. In short, we sought to assess the8supplemental laboratory indice of the AHA recommendations for diagnosising suspected iKD.Objects and Method1. Objects and grouping93patients with KD admitted to the Third Affiliated Hospital of Zhengzhou University between Jan,2006to Dec,2010were included in the study. KD Patients were divided into iKD and cKD group, control group:45cases (iKD control group) with sepsis which had no differences in age and gender at the close period were choosed.2. MethodClinical data collection:patients’s age, gender,the date of onset, diagnosing time, the clinical manifestations, laboratory test changes, ultrasonic cardiogram, ect. Analysis:(1) clinical features of93cases of kawasaki disease;(2) the comparison of the two groups with cKD iKD in general, clinical manifestations, laboratory examination indice,the incidence ofcoronary lesions;(3) to compare the eight supplemental laboratory indice suggested by the American Heart Association between the iKD group and the sepisis group.3. Statistics analysisData are expressed as mean (SD), median (range), or percentage (number). Independent-sample t test was used in different groups. Count data was analysed by Chi-square test. P<0.05was considered as statistically significant. All the results were analysed by SPSS13.0statistical software.Results1Among our reported93KD patients during the5-year period,93.55%were younger than5years,and more boys (accounted72.04%)are easily gotten than girls.The most number of93patients was consistently reported in July(summer).There were different seasonal peaks of KD incidence between boys and gilrs,boys were in summer and girls in spring. The other five clinical manifestation incidence from high to low in turn is:oral change, oral change, pleomorphic exanthem, conjunctival injection, changes in the extremities, neck lymphadenopathy.The total CAL rate was33.3%.The prevalences of coronary artery dilatation, aneurysm, and giant aneurysm after KD onset were26.9%,5.4%, and1.1%, respectively during the2006-2010study period.2The children with iKD which diagnose time were longer than that cKD had lower incidence of all5major manifestaion(except for fever).There were no significant differences between the iKD group and the cKD group in the eight laboratory indice level (P all>0.05). The prevalences of CAL was58.33%in36iKD Children, significantly higher than that17.54%in cKD Children (58.33vs17.54%, P<0.05).3About the positive ratio of the8laboratory indice, only the ESR positive ratio in iKD group was significantly higher than that in the sepisis group (80.56%vs33.33%, P<0.05), and there were statistical difference in the positive ratio of≥3Supplemental laboratory indices between the iKD group and the sepisis group (P<0.05).Conclusions1IKD have higher incidence ratio of CAL than cKD group.The two grous have similar laboratory measures. 2Being attention to the supplemental laboratory indice suggesting by the AHA, especially the ESR, would be helpful for the early diagnosis of iKD.