Analysis Of The Clinical Characteristics Of 32 Children With Shock Syndrome Of Kawasaki Disease And Preliminary Exploration Of Early Identification Of Risk Factors By Kawasaki Disease Shock Syndrome

Objective:The clinical characteristics of Kawasaki Disease Shock Syndrome(KDSS)were analyzed,and on this basis,the related risk factors were explored for early identification of KDSS,so as to provide clinical basis for early identification,systematic evaluation,timely diagnosis and treatment and improvement of prognosis of KDSS.Methods:The clinical data,laboratory examination,imaging examination,treatment and outcome of 32 children with KDSS admitted to the Department of Rheumatology and immunology of Shenzhen Children’s Hospital from January 2016 to October 2020 were retrospectively analyzed.The 97 cases in the same period hemodynamically stable children with Kawasaki disease(KD)and 28 children with septic shock(SS)were used as controls.Multiple logistic regression methods were used to explore the early identification of risk factors for KDSS.Results:(1)The median age of onset,duration of fever and length of hospital stay in KDSS group were significantly higher than those in KD group,and the incidence of polymorphous rash in KDSS group was significantly higher than that in KD group(P <0.05).(2)The KDSS group is prone to suffer multiple system damage,with the digestive system,cardiovascular system and respiratory system damage ranking the top three.(3)In the acute phase the incidence of coronary dilatation,mitral regurgitation and pericardial effusion in KDSS group was significantly higher than that in KD group,and the coronary dilatation rate was generally higher than that in KD group within 8 weeks of follow-up,the differences were statistically significant(P < 0.05).(4)The levels of neutrophil count(N#),high sensitivity C-reactive protein(hs-CRP),total bilirubin(TBIL)and gamma glutamyl transpeptidase(γ-GT)in KDSS group were significantly higher in KD group and SS group,while the levels of lymphocyte count(L#),serum sodium ion(Na+)and serum potassium ion(K+)in KDSS group were significantly lower in KD group and SS group,and the differences were statistically significant(P<0.05).(5)Multivariate logistic regression found that L#<1.27*10^9/L,hs-CRP>143.3mg/L,serum Na+<131.0mmol/L,total bilirubin>18.25umol/L are the symptoms of early shock in children with KDSS early risk factors.(6)In terms of treatment and outcome,the incidence of IVIG non-response in KDSS group were higher than those in KD group,and the percentages of application of secondary gamma globulin,glucocorticoids,vasoactive drugs and human albumin were higher than those in KD group,and the differences were statistically significant(P<0.05).Conclusion:KDSS is characterized by rapid progression,severe inflammatory reaction,and prone to suffer multiple organ and system damage.The incidence of coronary artery dilatation and IVIG non-response is high in KDSS.When the laboratory examinations show decreased lymphocyte and serum Na+,and increased hs-CRP and total bilirubin,we should be alert to shock syndrome in KD children.