Kawasaki Disease and Clinical Outcome Disparities Among Black Children.
Kawasaki Disease and Clinical Outcome Disparities Among Black Children.
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黑人儿童中川崎和临床结果的差异。
DOI：
10.1016/j.jpeds.2020.09.052
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Shrestha S
中科院分区：
文献类型：
--
作者：
Padilla LA;Collins JL;Idigo AJ;Lau Y;Portman MA;Shrestha S
确定患有川崎病的黑人儿童在患病率、后遗症和对静脉注射丙种球蛋白（IVIG）治疗的反应方面是否存在差异。国际疾病分类代码被用来识别在美国东南部的一个三级中心住院的川崎儿童。纳入了根据美国心脏协会标准诊断和治疗的受试者。比较了黑人和白人之间的人口统计学、实验室、临床和超声心动图数据（2000-2015年）。我们的分析包括369名受试者（52%白人和48%黑人）的数据。在住院期间，没有观察到与及时入院、IVIG治疗或冠状动脉（CA）异常相关的显著差异。在发热10天内给予IVIG的患者中，黑人的IVIG应答率低于白人（86.6% vs 95.6%; P = 0.007）。黑人接受了更多的辅助药物（9.6% vs 2.6%; P = 0.003），住院时间更长（平均5 ± 3.9天vs 3.4 ± 2.2天; P = 0.001）。黑人的C反应蛋白水平和红细胞沉降率较高，血红蛋白、白蛋白和钠水平较低。在第二次随访超声心动图（14.5% vs 6.3%; P = 0.03）和第三次随访超声心动图（21.2% vs 6.9%; P = 0.01）时，黑人持续性CA异常的比例高于白人。与白色儿童相比，患有川崎病的黑人儿童IVIG难治性患病率更高，炎症更严重，辅助治疗更多，住院时间更长。尽管在诊断或初始治疗时间上没有种族差异，但在随访时黑人儿童中CA异常的持续性更高。
To determine whether Black children with Kawasaki disease exhibit disparities in prevalence, sequelae, and response to intravenous gamma globulin (IVIG) treatment. International Classification of Diseases codes were used to identify children with Kawasaki disease admitted to a tertiary center in the southeastern US. Subjects diagnosed and treated according to American Heart Association criteria were included. Demographic, laboratory, clinical, and echocardiographic data from the electronic medical record (2000-2015) were compared between Blacks and Whites. Data from 369 subjects (52% Whites and 48% Blacks) were included in our analysis. No significant differences related to timely admission, IVIG treatment, or coronary artery (CA) abnormalities during hospitalization were observed. Blacks showed lower IVIG response rates than Whites for patients administered IVIG within 10 days of fever onset (86.6% vs 95.6%; P = .007). Blacks received more ancillary drugs (9.6% vs 2.6%; P = .003), and endured longer hospitalizations (mean, 5 ± 3.9 days vs 3.4 ± 2.2 days; P = .001). Blacks presented with higher C-reactive protein level and erythrocyte sedimentation rate and lower hemoglobin, albumin, and sodium levels. Blacks had a higher proportion of persistent CA abnormalities than Whites at second follow-up echocardiogram (14.5% vs 6.3%; P = .03), and at third follow-up echocardiogram (21.2% vs 6.9%; P = .01). Compared with White children, Black children with Kawasaki disease had higher IVIG refractory prevalence, more severe inflammation, more ancillary treatments, and longer hospitalizations. Despite no racial differences in time to diagnosis or initial treatment, there was greater CA abnormality persistence among Black children at follow-up.
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