Clinical Characteristics Of Incomplete Kawasaki Disease And Risk Factors Of Intravenous Immunoglobulin-Resistant Kawasaki Disease

Objective:To compare and analyze the differences between incomplete Kawasaki disease(IKD)and complete Kawasaki disease(CKD)in clinical features,laboratory indicators and incidence of coronary artery lesion(CAL),improving the knowledge and diagnosis of incomplete Kawasaki disease.To explore the risk factors of intravenous immunoglobulin-resistant Kawasaki disease,identifying high-risk patients,adjusting treatment and reducing the incidence of coronary artery lesion.Methods:Clinical data of 1019 children with KD who met the study criteria were collected from January 2009 to December 2019 in the pediatric inpatient department of the First Hospital of Jilin University.Analyze retrospectively the differences between IKD(229 cases)and CKD(790 cases)in gender,age,clinical manifestations,laboratory indicators,incidence of coronary artery lesion and treatment.According to the treatment effect,children with KD were divided into two groups of intravenous immunoglobin-sensitive Kawasaki disease(954cases)and intravenous immunoglobin-resistant Kawasaki disease(65 cases).Univariate analysis was carried out to identify the clinical features with significant differences between the groups,and multivariate Logistic regression analysis was conducted to further identify the independent risk factors of IVIG-resistant KD.Results:General information:age of onset,IKD group was smaller than CKD group(P<0.05);in terms of gender,males were significantly higher than females in the CKD group(P <0.05);in the onset season,IKD group and CKD group were mainly in summer and autumn,and there was no statistical significance between the two groups.(2)Clinical manifestations:the duration of fever in the IKD group was 9.26 ±4.04 days,and the CKD group was 8.76±3.23 days.There was no significant difference between the two groups;The incidence of bilateral conjunctival injections,changes of lips and oral cavity,changes of peripheral extremities,polymorphous rash,nonsuppurative cervical lymphadenopathy.and perianal desquamation in IKD group were lower than those in CKD group(P< 0.05);The incidence of the redness at the sate of Bacille Calmette-Guerin in the IKD group was higher than that in the CKD group(P< 0.05).(3)Laboratory indicators: compared with CKD group the levels of PLT,ALB,LDH and CK-MB in IKD group were higher(P< 0.05).The level of HB in IKD group was lower than that in CKD group(P< 0.05);WBC,CRP and ESR were significantly increased in both groups,but the comparison was not statistically significant.(4)Incidence of coronary artery lesion and treatment: The incidence of CAL in IKD group was higher than that in CKD group(P< 0.05);The time of treatment in IKD group was later than that in CKD group(P<0.05);There was no significant difference in the incidence of IVIG non-response between the two groups.(5)Compared with the IVIG-sensitive KD group,the duration of disease at the time of treatment in the IVIG-resistant KD group was shorter,the levels of WBC,CRP,NEU %,ALT,total bilirubin and urine white cells were higher,and the levels of ALB and serum Na+ were lower(P< 0.05).(6)Multivariate Logistic regression analysis showed that higher level of CRP(OR = 1.007,95%CI: 1.002 ～ 1.012),higher level of LDH(OR = 1.005,95%CI: 1.002 ～ 1.008)and lower level of ALB(OR = 0.938,95%CI:0.880 ～ 0.999)were independent risk factors of IVIG-resistant KD.Conclusion:(1)Compared with children with CKD,children with IKD have a younger average age of onset,prone to occur the redness at the sate of Bacille Calmette-Guerin,and a higher incidence of coronary artery lesions.(2)Higher level of CRP,LDH and lower level of ALB are independent risk factors for children with IVIG-resistant KD.