Özlem Erdede, Kübra Alkan, Erdal Sarı, Serpil Değrmenci, R. G. Sezer Yamanel
{"title":"川崎病和misc患儿持续发热相关因素:一项回顾性队列研究","authors":"Özlem Erdede, Kübra Alkan, Erdal Sarı, Serpil Değrmenci, R. G. Sezer Yamanel","doi":"10.28982/josam.7928","DOIUrl":null,"url":null,"abstract":"Background/Aim: Prolonged fever in children presents a diagnostic challenge due to its diverse underlying causes. While infectious diseases historically played a primary role, recent shifts in disease patterns and the emergence of conditions such as multisystem inflammatory syndrome in children (MIS-C) have added complexity. Understanding factors contributing to prolonged fever, particularly the rise in MIS-C and Kawasaki Disease (KD), is vital for accurate diagnosis and timely intervention. This study aimed to identify the etiologies causing prolonged fever in children with temperatures exceeding 38°C for a minimum of 5 days and to examine its relationship with conditions like MIS-C and KD following the coronavirus disease 2019 (COVID-19) pandemic.\nMethods: We conducted a retrospective cohort study at a pediatric hospital in Istanbul, Turkey, involving 243 children aged 3 months to 17 years with prolonged fever (>38°C for ≥5 days) between April 2020 and October 2022. We collected data on patient demographics, clinical characteristics, laboratory results, and final diagnoses. The study categorized patients into Group 1 (KD and MIS-C) and Group 2 (other causes). We performed logistic regression analysis to identify factors associated with KD and MIS-C, using hospitalization days and levels of C-reactive protein (CRP), ferritin, and D-dimer. We calculated sensitivity, specificity, and likelihood ratio values and generated ROC (Receiver operating characteristic) curves. The threshold for statistical significance was set at P<0.05.\nResults: This study encompassed 243 patients with prolonged fever. The primary causes of admission included infection-related illnesses (60.91%, n=148), MIS-C (18.52%, n=45), and KD (10.70%, n=26). Significant differences were observed in lymphocyte count (P<0.001), CRP level (P<0.001), ferritin level (P<0.001), D-dimer level (P<0.001), hospitalization days (P<0.001), and echocardiographic findings (P<0.001) between the groups. Logistic regression analysis revealed noteworthy associations between the presence of KD and MIS-C and hospitalization days (P=0.001), elevated CRP levels (P=0.018), elevated ferritin levels (P=0.009), and elevated D-dimer levels (P=0.001). Ferritin exhibited an AUC (Area under curve) of 0.737 (P<0.001), and D-dimer demonstrated an AUC of 0.782 (P<0.001) in differentiating between the presence of KD and MIS-C.\nConclusion: The prevalence of infectious and inflammatory conditions remains high in cases of prolonged fever, with a noticeable increase in the occurrence of KD and MIS-C since the onset of the COVID-19 pandemic. Notably, ferritin, CRP, and D-dimer levels are valuable indicators for identifying children at elevated risk of developing KD and MIS-C. While data were collected during the epidemic, additional data collection beyond this period would be necessary.","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"20 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Factors linked to Kawasaki disease and MIS-C in children with prolonged fever: A retrospective cohort study\",\"authors\":\"Özlem Erdede, Kübra Alkan, Erdal Sarı, Serpil Değrmenci, R. G. Sezer Yamanel\",\"doi\":\"10.28982/josam.7928\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background/Aim: Prolonged fever in children presents a diagnostic challenge due to its diverse underlying causes. While infectious diseases historically played a primary role, recent shifts in disease patterns and the emergence of conditions such as multisystem inflammatory syndrome in children (MIS-C) have added complexity. Understanding factors contributing to prolonged fever, particularly the rise in MIS-C and Kawasaki Disease (KD), is vital for accurate diagnosis and timely intervention. This study aimed to identify the etiologies causing prolonged fever in children with temperatures exceeding 38°C for a minimum of 5 days and to examine its relationship with conditions like MIS-C and KD following the coronavirus disease 2019 (COVID-19) pandemic.\\nMethods: We conducted a retrospective cohort study at a pediatric hospital in Istanbul, Turkey, involving 243 children aged 3 months to 17 years with prolonged fever (>38°C for ≥5 days) between April 2020 and October 2022. We collected data on patient demographics, clinical characteristics, laboratory results, and final diagnoses. The study categorized patients into Group 1 (KD and MIS-C) and Group 2 (other causes). We performed logistic regression analysis to identify factors associated with KD and MIS-C, using hospitalization days and levels of C-reactive protein (CRP), ferritin, and D-dimer. We calculated sensitivity, specificity, and likelihood ratio values and generated ROC (Receiver operating characteristic) curves. The threshold for statistical significance was set at P<0.05.\\nResults: This study encompassed 243 patients with prolonged fever. The primary causes of admission included infection-related illnesses (60.91%, n=148), MIS-C (18.52%, n=45), and KD (10.70%, n=26). Significant differences were observed in lymphocyte count (P<0.001), CRP level (P<0.001), ferritin level (P<0.001), D-dimer level (P<0.001), hospitalization days (P<0.001), and echocardiographic findings (P<0.001) between the groups. Logistic regression analysis revealed noteworthy associations between the presence of KD and MIS-C and hospitalization days (P=0.001), elevated CRP levels (P=0.018), elevated ferritin levels (P=0.009), and elevated D-dimer levels (P=0.001). Ferritin exhibited an AUC (Area under curve) of 0.737 (P<0.001), and D-dimer demonstrated an AUC of 0.782 (P<0.001) in differentiating between the presence of KD and MIS-C.\\nConclusion: The prevalence of infectious and inflammatory conditions remains high in cases of prolonged fever, with a noticeable increase in the occurrence of KD and MIS-C since the onset of the COVID-19 pandemic. Notably, ferritin, CRP, and D-dimer levels are valuable indicators for identifying children at elevated risk of developing KD and MIS-C. While data were collected during the epidemic, additional data collection beyond this period would be necessary.\",\"PeriodicalId\":30878,\"journal\":{\"name\":\"International Journal of Surgery and Medicine\",\"volume\":\"20 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-09-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Surgery and Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.28982/josam.7928\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Surgery and Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.28982/josam.7928","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Factors linked to Kawasaki disease and MIS-C in children with prolonged fever: A retrospective cohort study
Background/Aim: Prolonged fever in children presents a diagnostic challenge due to its diverse underlying causes. While infectious diseases historically played a primary role, recent shifts in disease patterns and the emergence of conditions such as multisystem inflammatory syndrome in children (MIS-C) have added complexity. Understanding factors contributing to prolonged fever, particularly the rise in MIS-C and Kawasaki Disease (KD), is vital for accurate diagnosis and timely intervention. This study aimed to identify the etiologies causing prolonged fever in children with temperatures exceeding 38°C for a minimum of 5 days and to examine its relationship with conditions like MIS-C and KD following the coronavirus disease 2019 (COVID-19) pandemic.
Methods: We conducted a retrospective cohort study at a pediatric hospital in Istanbul, Turkey, involving 243 children aged 3 months to 17 years with prolonged fever (>38°C for ≥5 days) between April 2020 and October 2022. We collected data on patient demographics, clinical characteristics, laboratory results, and final diagnoses. The study categorized patients into Group 1 (KD and MIS-C) and Group 2 (other causes). We performed logistic regression analysis to identify factors associated with KD and MIS-C, using hospitalization days and levels of C-reactive protein (CRP), ferritin, and D-dimer. We calculated sensitivity, specificity, and likelihood ratio values and generated ROC (Receiver operating characteristic) curves. The threshold for statistical significance was set at P<0.05.
Results: This study encompassed 243 patients with prolonged fever. The primary causes of admission included infection-related illnesses (60.91%, n=148), MIS-C (18.52%, n=45), and KD (10.70%, n=26). Significant differences were observed in lymphocyte count (P<0.001), CRP level (P<0.001), ferritin level (P<0.001), D-dimer level (P<0.001), hospitalization days (P<0.001), and echocardiographic findings (P<0.001) between the groups. Logistic regression analysis revealed noteworthy associations between the presence of KD and MIS-C and hospitalization days (P=0.001), elevated CRP levels (P=0.018), elevated ferritin levels (P=0.009), and elevated D-dimer levels (P=0.001). Ferritin exhibited an AUC (Area under curve) of 0.737 (P<0.001), and D-dimer demonstrated an AUC of 0.782 (P<0.001) in differentiating between the presence of KD and MIS-C.
Conclusion: The prevalence of infectious and inflammatory conditions remains high in cases of prolonged fever, with a noticeable increase in the occurrence of KD and MIS-C since the onset of the COVID-19 pandemic. Notably, ferritin, CRP, and D-dimer levels are valuable indicators for identifying children at elevated risk of developing KD and MIS-C. While data were collected during the epidemic, additional data collection beyond this period would be necessary.