川崎病和misc患儿持续发热相关因素:一项回顾性队列研究

Özlem Erdede, Kübra Alkan, Erdal Sarı, Serpil Değrmenci, R. G. Sezer Yamanel
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引用次数: 0

摘要

背景/目的:儿童长期发热由于其多种潜在原因,对诊断提出了挑战。虽然传染病历来起着主要作用,但最近疾病模式的转变和儿童多系统炎症综合征(MIS-C)等病症的出现增加了复杂性。了解导致持续发热的因素,特别是misc和川崎病(KD)的增加,对于准确诊断和及时干预至关重要。本研究旨在确定导致温度超过38°C至少5天的儿童持续发烧的病因,并研究其与2019年冠状病毒病(COVID-19)大流行后MIS-C和KD等疾病的关系。方法:我们在土耳其伊斯坦布尔的一家儿科医院进行了一项回顾性队列研究,纳入了243名3个月至17岁的儿童,他们在2020年4月至2022年10月期间发烧时间延长(bbb38°C持续≥5天)。我们收集了患者人口统计学、临床特征、实验室结果和最终诊断的数据。研究将患者分为1组(KD和MIS-C)和2组(其他原因)。我们使用住院天数和c反应蛋白(CRP)、铁蛋白和d -二聚体水平进行了logistic回归分析,以确定与KD和MIS-C相关的因素。我们计算敏感性、特异性和似然比值,并生成ROC(受试者工作特征)曲线。差异有统计学意义的阈值为P<0.05。结果:本研究纳入243例持续发热患者。入院的主要原因包括感染相关疾病(60.91%,n=148)、MIS-C (18.52%, n=45)和KD (10.70%, n=26)。两组间淋巴细胞计数(P<0.001)、CRP水平(P<0.001)、铁蛋白水平(P<0.001)、d -二聚体水平(P<0.001)、住院天数(P<0.001)、超声心动图表现(P<0.001)差异均有统计学意义。Logistic回归分析显示,KD和MIS-C的存在与住院天数(P=0.001)、CRP水平升高(P=0.018)、铁蛋白水平升高(P=0.009)和d -二聚体水平升高(P=0.001)之间存在显著相关性。铁蛋白的AUC(曲线下面积)为0.737 (P<0.001), d -二聚体区分KD和MIS-C的AUC为0.782 (P<0.001)。结论:在持续发热病例中,传染病和炎症的患病率仍然很高,自2019冠状病毒病大流行以来,KD和MIS-C的发生率明显增加。值得注意的是,铁蛋白、CRP和d -二聚体水平是识别KD和MIS-C风险升高儿童的有价值指标。虽然在疫情期间收集了数据,但在此期间之后还需要收集更多数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.
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