Clinical Characteristics Of Incomplete Kawasaki Disease And Risk Factors For Coronary Artery Damage In Kawasaki Disease

Objective:To analyze the difference of the clinical characteristics and laboratory parameters between typical Kawasaki disease and incomplete Kawasaki disease,providing basis for the early clinical diagnosis of incomplete Kawasaki disease.To identify high-risk patients by exploring the risk factors of Kawasaki disease(KD),designing individualized treatment and follow-up protocol in order to benefit for the prognosis.Method:We enrolled the clinical data of 130 children with KD who received inpatient treatment in Department of Pediatrics,the first affiliated hospital of Nanchang university from January 1,2016,to December 31,2019,in accordance with the inclusion criteria of this study.130 patients with KD were allocated into the typical KD group(93 cases)and incomplete KD group(37 cases)according to the diagnosis standard,retrospectively analyzed their clinical data,including sex,age,clinical manifestations,laboratory results.In addition,according to the results of echocardiography,two groups were divided,named KD patients with coronary artery lesion(CAL)(41 cases)and KD patients without coronary artery lesion(NCAL)(89cases),risk factors potentially associated with CAL including age,gender,duration of fever,white blood cell count,the neutrophil-to-lymphocyte ratio(NLR),platelet count,C reactive protein(CRP),erythrocyte sedimentation rate,anemia,clinical diagnosis,ect firstly analyzed by the single-factor,and then,the independent risk factors were selected using a multivariate logistic regression analysis.Results:1.The age of patients in incomplete KD group was lower than that of typical KD group(P<0.05),two groups had no significant differences in sex ratio(P>0.05).Compared with typical KD group,incomplete KD group demonstrated longer averagefever duration(P<0.05),higher rate of BCG vaccination scar reaction(redness and swelling)(P < 0.05),lower rates of bulbar conjunctiva hyperemia,deradenoncus,changes of the limbs(swelling and peeling)(P<0.05).2.In the laboratory indexes,the average levels of leukocyte count and neutrophil count were higher in incomplete KD group than typical KD group(P<0.05),and the incomplete KD group patients had significant decreases in mean hemoglobin compared with typical KD group(P<0.05).3.Compared with NCAL group,CAL group demonstrated higher proportion of males(P<0.05),longer average fever duration(P<0.05).4.The average levels of leukocyte count,neutrophil count,the neutrophil-tolymphocyte ratio and C reactive protein at the acute stage of KD were higher in CAL group than NCAL group(P<0.05).5.The results of multivariate logistic regression analysis showed that males(OR= 3.737,95% CI: 1.240~11.267),earlier onset age(OR = 0.757,95% CI: 0.619~0.926),longer duration fever(OR = 1.514,95 % CI: 1.193~1.922),higher level of NLR(OR = 1.484,95% CI: 1.128~1.951),and higher level of CRP(OR = 1.011,95% CI: 1.003~1.018)were the independent risk factors for CAL.Conclusion:1.The average onset age of incomplete KD was relatively young,and its duration of fever was relatively long.BCG vaccination scar reaction had important implications for efforts to diagnose incomplete KD.2.Compared with typical KD,incomplete KD showed higher levels of leukocyte count and neutrophil count,higher rate of anemia.3.Males,earlier onset age,longer duration fever,higher level of NLR and CRP were the independent risk factors for CAL caused by Kawasaki disease.Additional attention and interventions should be considered in the patients with high risks for CAL.Echocardiogram examination should be performed as early as possible.And clinician should design individualized and careful follow-up protocol for them.