[Early differentiation of Kawasaki disease shock syndrome and septic shock in children].

Abstract

Objective: To explore the differences in early clinical features between Kawasaki disease shock syndrome (KDSS) and septic shock (SS). Methods: A retrospective case-control study was conducted. Clinical data was collected from 64 children who were diagnosed with KDSS or SS and admitted to the Department of Critical Care Medicine of Capital Center for Children's Health, Capital Medical University from January 2018 to February 2025. Mann-Whitney U test, χ² test, or Fisher's exact test were used to compare the differences in clinical features, treatment, and outcomes between children with KDSS and SS. Lasso regression was applied to screen predictive variables, and multivariable logistic regression analysis was performed to identify factors associated with KDSS. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of parameters for KDSS. Results: Among the 64 children (30 males and 34 females), the age w 3.6 (1.2, 6.5) years old. There were 51 cases in the SS group and 13 cases in the KDSS group. Compared to children with SS, children with KDSS had a longer pre-shock fever duration, lower lactate levels and serum albumin levels, and higher soluble interleukin-2 receptor (sIL-2R) levels (all P<0.05). Additionally, they exhibited a higher incidence of coronary involvement, pericardial effusion, and ascites, a higher utilization rate of intravenous immunoglobulin, and a lower utilization rate of invasive mechanical ventilation (all P<0.05). There was no significant difference in in-hospital mortality between KDSS and SS (P=0.574). Multivariate logistic regression analysis identified pre-shock fever duration and sIL-2R as independent factors associated with KDSS (OR=1.52 and 1.54 (per 1 000 U increase), 95%CI 1.12-2.05 and 1.06-2.24, respectively; botb P<0.05). ROC curve analysis showed that the areas under the curve for pre-shock fever duration and sIL-2R in identifying KDSS were 0.83 (95%CI 0.73-0.94, P=0.001) and 0.70 (95%CI 0.53-0.87, P=0.042), respectively. The optimal cutoff values were 3.5 d and 3.8×10⁶ U/L, with sensitivities of 0.91 and 0.82, and specificities of 0.71 and 0.62, respectively. Conclusions: Children with KDSS have higher incidences of coronary involvement, pericardial effusion, and ascites compared to those with SS. Pre-shock fever duration and sIL-2R may serve as potential early indicators for distinguishing KDSS from SS.