Kawasaki disease in a pediatric intensive care unit: A case-control study
Kawasaki disease in a pediatric intensive care unit: A case-control study
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DOI：
10.1542/peds.2008-1275
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发表时间：
2008-10-01
期刊：
影响因子：
8
通讯作者：
Glode, Mary P.
中科院分区：
文献类型：
--
作者：
Dominguez, Samuel R.;Friedman, Kevin;Glode, Mary P.
目标.我们进行了一项病例对照研究，以确定儿童谁有川崎病，并在我们的儿童医院ICU的临床表现，危险因素和临床结果。我们回顾了从1995年到2007年所有出院诊断为川崎并入住ICU的儿童的病历。对于每例患者，我们确定了3名季节匹配的对照受试者，他们患有川崎病，未入住ICU。我们确定了423例川崎患者。其中，14例（3.3%）入住ICU，符合我们的入选标准。ICU入院诊断最常见的是中毒性休克或感染性休克。14例ICU患者中有13例（92.8%）在治疗前符合完全性川崎标准。与季节匹配的川崎对照组相比，ICU患者的年龄无显著差异。ICU患者明显更可能是女性，并且具有较高的条带计数、较低的血小板计数、较低的白蛋白水平和较高的C反应蛋白值。ICU患者从入院到静脉注射免疫球蛋白治疗的时间延迟。ICU患者更可能患有静脉免疫球蛋白难治性疾病，需要第二次静脉免疫球蛋白、英夫利西单抗或类固醇治疗。我们对患有川崎并表现为严重疾病、休克和需要入住ICU的患者进行病例对照研究。这些患者经常被误诊，因为未能认识到疾病的严重程度，在川崎病患者的全谱。这些患者的疾病经常被误认为是中毒性或感染性休克，导致静脉注射免疫球蛋白治疗的延迟。患有川崎并入住ICU的患者发生静脉免疫球蛋白难治性疾病的风险增加，并可能发生更严重的冠状动脉疾病。
OBJECTIVES. We conducted a case-control study to ascertain the clinical presentations, risk factors, and clinical outcomes of children who had Kawasaki disease and were admitted to the ICU of our children's hospital.METHODS. We reviewed charts of all children who had a discharge diagnosis of Kawasaki disease and were admitted to the ICU from 1995 through 2007. For each patient, we identified 3 season-matched control subjects who had Kawasaki disease and were not admitted to the ICU.RESULTS. We identified 423 patients with Kawasaki disease. Of those, 14 (3.3%) were admitted to the ICU and met our inclusion criteria. ICU admission diagnoses were most commonly toxic shock or septic shock. Thirteen (92.8%) of 14 patients who were admitted to the ICU met criteria for complete Kawasaki disease before treatment. There was no significant difference in age in ICU patients compared with season-matched control subjects with Kawasaki disease. ICU patients were significantly more likely to be female and to have higher band counts, lower platelet counts, lower albumin levels, and higher C-reactive protein values. Time from admission to treatment with intravenous immunoglobulin was delayed in ICU patients. ICU patients were more likely to have intravenous immunoglobulin-refractory disease and require therapy with a second dose of intravenous immunoglobulin, infliximab, or steroids.CONCLUSIONS. We present a case-control study of patients who had Kawasaki disease and presented severely ill, in shock, and requiring admission to the ICU. These patients frequently were misdiagnosed because of failure to appreciate the full spectrum of disease severity seen in patients with Kawasaki disease. These patients' illnesses was often mistaken for toxic or septic shock, leading to a delay in treatment with intravenous immunoglobulin. Patients who have Kawasaki disease and are admitted to the ICU are at increased risk for intravenous immunoglobulin-refractory disease and may be at risk for development of more severe coronary artery disease.