The impact of inappropriate steroid exposure before the diagnosis of Kawasaki disease

IF 2.3 4区 医学 Q2 PEDIATRICS Pediatrics and Neonatology Pub Date : 2024-07-01 DOI:10.1016/j.pedneo.2023.09.009
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引用次数: 0

Abstract

Background

Kawasaki disease (KD) is a systemic inflammatory disease characterized by vasculitis. In South Korea, some pediatric doctors empirically prescribe steroids to control febrile pediatric patients. This study aimed to evaluate the clinical characteristics of patients with KD after steroid exposure.

Methods

This was a single-center, retrospective, observational study. This study included patients (aged ≤15 years) between January 2020 and July 2022. We compared two groups, one group exposed to steroids and the other group who were not, using the Student's t-test or analysis of variance; otherwise, the Mann–Whitney U test or Kruskal–Wallis test was conducted. Statistical significance was set at p < 0.05.

Results

In total, 190 patients with KD were enrolled; of these, 64 (33.7 %) had a history of steroid exposure, and 126 (66.3 %) had no history of steroid exposure. In the steroid exposure group, prolonged fever duration (6.72 ± 1.72 versus 5.61 ± 1.19, p-value = <0.001), a lower proportion of complete KD (29.69 % vs. 88.10 %, p-value = <0.001), and a significantly lower level of C-reactive protein were observed. However, no significant correlations were observed between the Transthoracic Echocardiography (TTE) results (coronary artery aneurysm, existence of pericardial effusion) and prognostic factors (days of hospitalization, the number of intravenous immunoglobulin administrations, and Kobayashi score) between the two groups.

Conclusions

Patients with KD and previous steroid exposure may exhibit an incomplete KD phenotype with prolonged fever. Although previous steroid exposure does not affect the prognosis of KD, including coronary artery aneurysms, it may mask the classic features of KD, resulting in a delayed diagnosis.

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川崎病确诊前不当使用类固醇的影响
背景川崎病(KD)是一种以血管炎为特征的全身性炎症性疾病。在韩国,儿科医生会根据经验处方类固醇来控制发热的儿科患者。本研究旨在评估接触类固醇后 KD 患者的临床特征。本研究纳入了2020年1月至2022年7月期间的患者(年龄≤15岁)。我们采用学生 t 检验或方差分析对两组患者进行了比较,一组暴露于类固醇,另一组未暴露于类固醇,否则采用 Mann-Whitney U 检验或 Kruskal-Wallis 检验。统计显著性以 p < 0.05 为标准。结果共纳入 190 名 KD 患者,其中 64 人(33.7%)有类固醇接触史,126 人(66.3%)无类固醇接触史。在类固醇暴露组中,观察到发热持续时间延长(6.72 ± 1.72 对 5.61 ± 1.19,p 值 = <0.001)、完全 KD 的比例降低(29.69 % 对 88.10 %,p 值 = <0.001)以及 C 反应蛋白水平显著降低。然而,两组患者的经胸超声心动图(TTE)结果(冠状动脉瘤、心包积液)和预后因素(住院天数、静脉注射免疫球蛋白的次数和小林评分)之间未发现明显相关性。虽然既往接触过类固醇不会影响 KD(包括冠状动脉瘤)的预后,但它可能会掩盖 KD 的典型特征,从而导致延误诊断。
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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
170
审稿时长
48 days
期刊介绍: Pediatrics and Neonatology is the official peer-reviewed publication of the Taiwan Pediatric Association and The Society of Neonatology ROC, and is indexed in EMBASE and SCOPUS. Articles on clinical and laboratory research in pediatrics and related fields are eligible for consideration.
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