Supriya S. Jain MD , Ashraf S. Harahsheh MD , Simon Lee MD , Geetha Raghuveer MD , Nagib Dahdah MD, MBA , Michael Khoury MD , Michael A. Portman MD , Melissa Wehrmann MD , Arash A. Sabati MD , Marianna Fabi MD, PhD , Deepika Thacker MD , Nilanjana Misra MBBS , Mark D. Hicar MD, PhD , Nadine F. Choueiter MD , Matthew D. Elias MD , Audrey Dionne MD , William B. Orr MD , Jacqueline R. Szmuszkovicz MD , Seda Selamet Tierney MD , Luis Martin Garrido-Garcia MD, MSc , Varsha Zadokar MBBS
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引用次数: 0
Abstract
Background
While clinical overlap between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) has been evident, information regarding those presenting with shock has been limited. We sought to determine associations with shock within and between diagnosis groups.
Methods
The International KD Registry enrolled contemporaneous patients with either KD or MIS-C from 39 sites in 7 countries from January 1, 2020, to January 1, 2023. Demographics, clinical features and presentation, management, laboratory values, and outcomes were compared between the diagnosis and shock groups.
Results
Shock at presentation was noted for 19 of 672 KD patients (2.8%) and 653 of 1472 MIS-C patients (44%; P < 0.001). Within both groups, patients with shock were significantly more likely to be admitted to the intensive care unit, to receive inotropes, and to have greater laboratory abnormalities indicative of hyperinflammation and organ dysfunction, including abnormal cardiac biomarkers. Patients with KD and shock had a greater maximum coronary artery z score (median +2.62) vs KD patients without shock (+1.36; P < 0.001) and MIS-C patients with shock (+1.45 [vs +1.32 for MIS-C patients without shock]; P < 0.001). They were also more likely to have large coronary artery aneurysms. In contrast, MIS-C patients with shock had lower left ventricular ejection fraction (mean 51.6%) vs MIS-C patients without shock (56.6%; P < 0.001) and KD patients with shock (56.7% [vs 62.8% for KD patients without shock]; P = 0.04).
Conclusions
Although patients with KD presenting with shock are clinically similar to patients with MIS-C, especially those with shock, they have more severe coronary artery involvement, whereas MIS-C patients with shock have lower left ventricular ejection fraction.
期刊介绍:
The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.