Research Article


DOI :10.26650/jchild.2022.828877   IUP :10.26650/jchild.2022.828877    Full Text (PDF)

Evaluation of Clinical, Laboratory Findings and Prognosis in Kawasakı Patients

Mavera Uşaklıoğlu ErolAygün DindarKemal NişliRukiye Eker Ömeroğlu

Objective: Kawasaki disease is a vasculitis associated with acute fever in children. Conjunctivitis, rash, erythema of the lips and oral mucosa, edema of the extremities, redness, peeling and cervical lymphadenopathy are seen along with fever. Vasculitis frequently affects the coronary arteries. Coronary artery involvement is the most important predictor of prognosis. In this study, we aimed to evaluate the clinical, laboratory and echocardiographic findings and prognosis of patients diagnosed with Kawasaki disease. Materials and Methods: The clinical, laboratory characteristics, treatment and follow-up results of 66 patients aged between 6 months and 91 months admitted to our hospital between 2004-2019 and diagnosed as Kawasaki disease were evaluated retrospectively. Results: 38% of the patients were female and 62% were male. The I/F ratio was 1.64. The mean age at diagnosis was 32±21 months. 38.5% of these patients were at the age of 1 year or less, and 52.3% were between 1 and 5 years of age. 27 patients (40.9%) were diagnosed as incomplete Kawasaki, and 39 patients (59.1%) were complete Kawasaki. Incomplete cases were more frequent under the age of 1 year (p=0.002). The most common clinical finding after fever was lip and oral mucosal changes (84.8%). 72.7% of the patients had anemia. There was a statistically significant difference between thrombocyte and leukocyte values at admission and control (p<0.001). The age at diagnosis, Hb, sodium, albumin was lower in patients with coronary involvement than in patients without coronary involvement; ESR, CRP, leukocyte at admission, thrombocyte in second week, HDL, LDL, VLDL, total cholesterol, ALT, AST, proBNP levels before and after IVIG were found to be high. In 54.6% of the patients, there was dilatation of the coronary arteries, and aneurysm in one patient. On admission, 79% of 43 cases with coronary abnormality had normalized, 7 had dilatation of the coronary artery, and 2 had coronary artery aneurysm. All patients were given IVIG and acetyl salicylic acid. Eight patients received a second dose of IVIG. Steroid was administered to 2 patients who were resistant to IVIG treatment. Primary additional therapies were applied to 3 cases with infarction of coronary arteries, and giant and middle aneurysm. No deaths were observed. Conclusion: Early diagnosis and treatment of Kawasaki disease can prevent serious and lifelong complications. Since Kawasaki disease has not a prognostic finding and a marker, the discovery of new markers is an important research area.

DOI :10.26650/jchild.2022.828877   IUP :10.26650/jchild.2022.828877    Full Text (PDF)

Kawasaki Hastalarında Klinik, Laboratuvar Bulguların ve Prognozun Değerlendirilmesi

Mavera Uşaklıoğlu ErolAygün DindarKemal NişliRukiye Eker Ömeroğlu

Amaç: Kawasaki hastalığı çocuklarda düşmeyen ateş ile giden bir vaskülittir. Ateşin yanında konjonktivit, döküntü, dudaklarda ve oral mukozada eritem, ekstremitelerde ödem, kızarıklık, soyulma ve servikal lenfadenopati görülür. Vaskülit sıklıkla koroner arterleri etkilemektedir. Koroner arter tutulumu prognozu belirleyen en önemli faktördür. Bu çalışmada Kawasaki hastalığı tanısı almış olan vakaların klinik, laboratuvar ve ekokardiyografik bulguları ile prognozlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: 2004-2019 yılları arasında hastanemize başvurup Kawasaki hastalığı tanısı alan yaşları 6-91 ay arasında değişen 66 hastanın klinik, laboratuvar özellikleri, tedavi ve izlem sonuçları geriye dönük olarak değerlendirildi. Bulgular: Hastaların %38’i kız, %62’si erkekti. Tanı anındaki ortalama yaş 32±21 aydı. Hastaların %52,3’ü 1-5 yaş aralığındaydı. Hastaların %40,9’u inkomplet Kawasaki, %59,1’i ise komplet Kawasaki kriterlerine uymakta idi. İnkomplet vakaların bir yaş altında daha sık olduğu gözlendi. Ateşten sonra en sık görülen klinik bulgu dudak ve oral mukoza değişikliğiydi. Koroner tutulumu olan hastalarda koroner tutulumu olmayan hastalara göre tanı yaşı, hemoglobin (Hb), sodyum, albümin düşük; eritrosit sedimentasyon hızı (ESH), C-reaktif protein (CRP), başvuru sırasındaki lökosit (WBC), kontrolde bakılan trombosit (PLT), lipoproteinler, total kolesterol, alanin aminotransferaz (ALT), aspartat aminotransferaz (AST), intravenöz immünglobulin (IVIG) öncesi ve sonrası pro beyin natriüretik peptit (proBNP) değerleri yüksek saptandı. Hastaların %54,6’sında başvurduğunda koroner arterlerde dilatasyon ve bir hastada anevrizma mevcuttu. Başvurusunda koroner anormalliği olan 43 vakanın %79’unun normalleştiği, yedisinde koroner arterde dilatasyonun devam ettiği, ikisinde ise koroner arter anevrizması geliştiği saptandı. Hastaların hepsine IVIG ve asetil salisilik asit verilmişti. Sekiz hastaya ikinci doz IVIG verildi. IVIG tedavisine dirençli iki olguya steroid uygulandı. Ölüm gözlenmedi. Sonuç: Kawasaki hastalığının erken tanınarak akut dönemde tedavi edilmesiyle ciddi ve yaşam boyu sürecek komplikasyonları engellemek mümkündür. Kawasaki hastalığının prognostik bir bulgu ve belirteci olmaması nedeniyle yeni belirteçlerin keşfi önemli bir araştırma alanıdır.


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References

  • 1. Kuo HC, Li SC, Guo MM, Huang YH, Yu HR, Huang FC, et.al. Genome-Wide Association Study Identifies Novel Susceptibility Genes Associated with Coronary Artery Aneurysm Formation in Kawasaki Disease. PLoS One 2016;11(5):e0154943. google scholar
  • 2. Rowley AH, Shulman ST. Kawasaki disease. Nelson Textbook of Pediatrics, Behrman RE, Kliegman RM, Jenson HB (eds), 16th ed., Philadelphia, W.B. Saunders Company, 2000; s. 725-7. google scholar
  • 3. Greco A, De Virgilio A, Rizzo M. Tombolini M, Gallo A, Fusconi M, et al. Kawasaki disease: an evolving paradigm. Autoimmun Rev 2015;14(8):703-9. google scholar
  • 4. Nakamura Y, Yashiro M, Uehara R, Sadakane A, Tsuboi S, Aoyama Y, et al. Epidemiologic features of Kawasaki disease in Japan: results of the 2009-2010 nationwide survey. J Epidemiol 2012;22(3):216-21. google scholar
  • 5. Holman RC, Belay ED, Christensen KY, Folkema AM, Steiner CA, Schonberger LB. Hospitalizations for Kawasaki syndrome among children in the United States, 1997-2007. Pediatr Infect Dis J 2010;29(6):483-8. google scholar
  • 6. Lin YT, Manlhiot C, Ching JC, Han RK, Nield LE, Dillenburg R, et al. Repeated systematic surveillance of Kawasaki disease in Ontario from 1995 to 2006. Pediatr Int 2010;52(5):699-706. google scholar
  • 7. Makino N, Nakamura Y, Yashiro M, Kosami K, Matsubara Y, Ae R, et.al. Nationwide epidemiologic survey of Kawasaki disease in Japan, 2015-2016. Pediatr Int 2019;61(4):397-403. google scholar
  • 8. Saundankar J, Yim D, Itotoh B, Payne R, Maslin K, Jape G, et al. The epidemiology and clinical features of Kawasaki disease in Australia. Pediatrics 2014;133(4):e1009-14. google scholar
  • 9. Fernândez-Cooke E, Barrios Tascon A, Sânchez-Manubens J, Anton J, Grasa Lozano CD, Aracil Santos J, et.al.; KAWA-RACE study group. Epidemiological and clinical features of Kawasaki disease in Spain over 5 years and risk factors for aneurysm development. (20112016): KAWA-RACE study group. PloS One 2019;14(5):e0215665. google scholar
  • 10. Burns JC, Glode MP. Kawasaki syndrome. Lancet 2004;364(9433):533-44. google scholar
  • 11. Kuo HC, Yang KD, Chang WC, Ger LP, Hsieh KS. Kawasaki disease: an update on diagnosis and treatment. Pediatr Neonatol 2012;53(1):4-11. google scholar
  • 12. McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et. al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association Circulation 2017;135(17):e927-e999. google scholar
  • 13. Sun YP, Wei CP, Wen-di Wang XCZ, Wang YJ, Ma SC, Xu YJ, et al. Serum brain natriuretic peptide in children with Kawasaki disease. World J Emerg Med 2010;1(2): 114-7. google scholar
  • 14. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and longterm management of Kawasaki disease: A statement for health professionals from the committee on rheumatic fever, endocarditis, and Kawasaki disease, council on cardiovascular disease in the young, American Heart Association. Circulation 2004;110(17):2747-71. google scholar
  • 15. AL-Ammouri I, Al-Wahsh S, Khuri-Bulos N. Kawasaki disease in Jordan: demographics, presentation, and outcome. Cardiol Young 2012;22(4):390-5. google scholar
  • 16. Chen JJ, Ma XJ, Liu F, Yan WL, Huang MR, Huang M, et al. Epidemiologic Features of Kawasaki Disease in Shanghai from 2008 Through 2012. Pediatr Infect Dis J 2016;35(1):7-12. google scholar
  • 17. Yanagawa H, Yashiro M, Nakamura Y, Kawasaki T, Kato H. Epidemiologic pictures of Kawasaki disease in Japan: from the nationwide incidence survey in 1991 and 1992. Pediatrics. 1995;95(4):475-9. google scholar
  • 18. Özyürek R, Levent E, Ülger Z, Gürses D. Kawasaki Hastalığı: 11 vakanın değerlendirilmesi. Çocuk Sağlığı ve Hastalıkları Dergisi 2004;47:167-171. google scholar

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APA

Uşaklıoğlu Erol, M., Dindar, A., Nişli, K., & Eker Ömeroğlu, R. (2022). Evaluation of Clinical, Laboratory Findings and Prognosis in Kawasakı Patients. Journal of Child, 22(2), 75-79. https://doi.org/10.26650/jchild.2022.828877


AMA

Uşaklıoğlu Erol M, Dindar A, Nişli K, Eker Ömeroğlu R. Evaluation of Clinical, Laboratory Findings and Prognosis in Kawasakı Patients. Journal of Child. 2022;22(2):75-79. https://doi.org/10.26650/jchild.2022.828877


ABNT

Uşaklıoğlu Erol, M.; Dindar, A.; Nişli, K.; Eker Ömeroğlu, R. Evaluation of Clinical, Laboratory Findings and Prognosis in Kawasakı Patients. Journal of Child, [Publisher Location], v. 22, n. 2, p. 75-79, 2022.


Chicago: Author-Date Style

Uşaklıoğlu Erol, Mavera, and Aygün Dindar and Kemal Nişli and Rukiye Eker Ömeroğlu. 2022. “Evaluation of Clinical, Laboratory Findings and Prognosis in Kawasakı Patients.” Journal of Child 22, no. 2: 75-79. https://doi.org/10.26650/jchild.2022.828877


Chicago: Humanities Style

Uşaklıoğlu Erol, Mavera, and Aygün Dindar and Kemal Nişli and Rukiye Eker Ömeroğlu. Evaluation of Clinical, Laboratory Findings and Prognosis in Kawasakı Patients.” Journal of Child 22, no. 2 (Oct. 2022): 75-79. https://doi.org/10.26650/jchild.2022.828877


Harvard: Australian Style

Uşaklıoğlu Erol, M & Dindar, A & Nişli, K & Eker Ömeroğlu, R 2022, 'Evaluation of Clinical, Laboratory Findings and Prognosis in Kawasakı Patients', Journal of Child, vol. 22, no. 2, pp. 75-79, viewed 5 Oct. 2022, https://doi.org/10.26650/jchild.2022.828877


Harvard: Author-Date Style

Uşaklıoğlu Erol, M. and Dindar, A. and Nişli, K. and Eker Ömeroğlu, R. (2022) ‘Evaluation of Clinical, Laboratory Findings and Prognosis in Kawasakı Patients’, Journal of Child, 22(2), pp. 75-79. https://doi.org/10.26650/jchild.2022.828877 (5 Oct. 2022).


MLA

Uşaklıoğlu Erol, Mavera, and Aygün Dindar and Kemal Nişli and Rukiye Eker Ömeroğlu. Evaluation of Clinical, Laboratory Findings and Prognosis in Kawasakı Patients.” Journal of Child, vol. 22, no. 2, 2022, pp. 75-79. [Database Container], https://doi.org/10.26650/jchild.2022.828877


Vancouver

Uşaklıoğlu Erol M, Dindar A, Nişli K, Eker Ömeroğlu R. Evaluation of Clinical, Laboratory Findings and Prognosis in Kawasakı Patients. Journal of Child [Internet]. 5 Oct. 2022 [cited 5 Oct. 2022];22(2):75-79. Available from: https://doi.org/10.26650/jchild.2022.828877 doi: 10.26650/jchild.2022.828877


ISNAD

Uşaklıoğlu Erol, Mavera - Dindar, Aygün - Nişli, Kemal - Eker Ömeroğlu, Rukiye. Evaluation of Clinical, Laboratory Findings and Prognosis in Kawasakı Patients”. Journal of Child 22/2 (Oct. 2022): 75-79. https://doi.org/10.26650/jchild.2022.828877



TIMELINE


Submitted19.12.2020
Accepted13.07.2021
Published Online09.09.2022

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