A Comparison of Kawasaki Disease during the SARS-CoV-2 Pandemic with Multisystem Inflammatory Syndrome in Children.

IF 2 4区医学 Q2 PEDIATRICS Children-Basel Pub Date : 2024-09-28 DOI:10.3390/children11101185

Tunç Tunçer, Fatih Varol

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Abstract

Objectives: The purpose of this study was to compare and contrast Kawasaki disease (KD) with multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic.

Methods: A retrospective analysis of the medical records of patients diagnosed with KD and MIS-C at a single institution from July 2020 to November 2021 was performed.

Results: The study included 39 MIS-C patients (84.6% male) with a median age of 138 months and 17 KD patients (58.8% male) with a median age of 36 months. The MIS-C patients were older (p < 0.001) and had prolonged hospitalizations (p = 0.023), elevated neutrophil counts (p < 0.001), C-reactive protein (p < 0.001), procalcitonin (p < 0.001), interleukin-6 (p < 0.014), ferritin (p < 0.001), fibrinogen (p < 0.001), troponin I (p = 0.001), NT-proBNP (p < 0.001), and D-dimer levels (p < 0.001). There were more cases of hypotension (p = 0.024), decreased left ventricular function (p = 0.023), and a greater need for corticosteroids (p < 0.001), enoxaparin (p = 0.045), and therapeutic plasma exchange (p < 0.001). Kawasaki disease patients had a greater incidence of rash (p < 0.001), changes in oral mucosa (p < 0.001), conjunctival injection (p < 0.001), extremity changes (p < 0.001), and cervical lymphadenopathy (p < 0.001). They had a longer duration of fever (p < 0.001), elevated white blood cell count (p < 0.001), platelet count (p < 0.001), and alanine aminotransferase level (p < 0.001). The two groups were similar regarding the hemoglobin levels, erythrocyte sedimentation rates, albumin levels, and the frequency of coronary aneurysm, myocarditis, pericarditis, invasive mechanical ventilatory support, and intravenous immunoglobulin treatment.

Conclusions: Advanced patient age, a greater presence of gastrointestinal and cardiac findings associated with hypotension, increased NT-proBNP levels, decreased left ventricular function, the use of various treatment modalities, and longer hospital stays suggest MIS-C, whereas prolonged fever and classical clinical features of KD favor KD.

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SARS-CoV-2 大流行期间川崎病与儿童多系统炎症综合征的比较。

研究目的本研究旨在比较和对比SARS-CoV-2大流行期间川崎病（KD）与儿童多系统炎症综合征（MIS-C）：方法：对一家医疗机构 2020 年 7 月至 2021 年 11 月期间诊断为 KD 和 MIS-C 患者的病历进行回顾性分析：研究包括39名MIS-C患者（84.6%为男性），中位年龄为138个月；17名KD患者（58.8%为男性），中位年龄为36个月。MIS-C 患者年龄更大（p < 0.001），住院时间更长（p = 0.023），中性粒细胞计数升高（p < 0.001），C 反应蛋白升高（p < 0.001），降钙素原升高（p < 0.001）、白细胞介素-6（p < 0.014）、铁蛋白（p < 0.001）、纤维蛋白原（p < 0.001）、肌钙蛋白 I（p = 0.001）、NT-proBNP（p < 0.001）和 D-二聚体水平（p < 0.001）。出现低血压（p = 0.024）、左心室功能下降（p = 0.023）的病例更多，需要使用皮质类固醇（p < 0.001）、依诺肝素（p = 0.045）和治疗性血浆置换（p < 0.001）的病例更多。川崎病患者皮疹（p < 0.001）、口腔粘膜变化（p < 0.001）、结膜注射（p < 0.001）、四肢变化（p < 0.001）和颈淋巴结病（p < 0.001）的发病率较高。他们的发热持续时间较长（p < 0.001），白细胞计数升高（p < 0.001），血小板计数升高（p < 0.001），丙氨酸氨基转移酶水平升高（p < 0.001）。两组患者的血红蛋白水平、红细胞沉降率、白蛋白水平以及冠状动脉瘤、心肌炎、心包炎、有创机械通气支持和静脉注射免疫球蛋白治疗的频率相似：结论：患者年龄较大、胃肠道和心脏症状较多并伴有低血压、NT-proBNP 水平升高、左心室功能减退、使用各种治疗方法以及住院时间较长，这些都提示 MIS-C，而长期发热和 KD 的典型临床特征则有利于 KD。

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来源期刊

Children-Basel PEDIATRICS-

CiteScore

2.70

自引率

16.70%

发文量

1735

审稿时长

6 weeks

期刊介绍： Children is an international, open access journal dedicated to a streamlined, yet scientifically rigorous, dissemination of peer-reviewed science related to childhood health and disease in developed and developing countries. The publication focuses on sharing clinical, epidemiological and translational science relevant to children’s health. Moreover, the primary goals of the publication are to highlight under‑represented pediatric disciplines, to emphasize interdisciplinary research and to disseminate advances in knowledge in global child health. In addition to original research, the journal publishes expert editorials and commentaries, clinical case reports, and insightful communications reflecting the latest developments in pediatric medicine. By publishing meritorious articles as soon as the editorial review process is completed, rather than at predefined intervals, Children also permits rapid open access sharing of new information, allowing us to reach the broadest audience in the most expedient fashion.