Retrospective evaluation of kawasaki disease with clinical and laboratory findings and determination of risk factors in coronary artery involvement: Ege University Faculty of Medicine Pediatric Cardiology experience

Introduction: Kawasaki disease is the most common systemic vasculitis seen between 6 months and 5 years of age and is the leading cause of acquired heart disease in children in developed countries. There is no specific test for the diagnosis of Kawasaki disease. The diagnosis of the disease is made by the presence of five of the six main criteria, including fever, changes in extremity extremities, polymorphic exanthema, bilateral conjunctival congestion, changes in the oropharyngeal mucosa, and cervical lymphadenopathy. In the developed guidelines, detecting 3 of the clinical findings and distinguishing other possible infections in the presence of fever lasting more than 5 days is considered sufficient for the diagnosis of Kawasaki disease and is called as atypical Kawasaki disease. Various publications have reported that 7-10% of Kawasaki disease is observed atypically. The risk of develini coronary artery aneurysms is as high as that of typical Kawasaki disease, indicating the importance of early treatment in these patients. Therefore, Kawasaki disease should be considered in infants with prolonged, unexplained fever and signs of mucocutaneous inflammation and echocardiography should be performed. There are three clinical stages of the disease. Acute febrile phase lasts for 1-2 weeks, diagnostic findings are observed at this stage, while coronary aneurysm is not usually observed on echocardiography. The subacute phase begins when fever, rash, and lymphadenopathy resolve, lasts until the end of the 4th week, peels and thrombocytosis develops in the fingers, coronary artery lesions are the most common stage and the risk of sudden death is highest. The treatment is based on IVIG and ASA. Coronary abnormalities develop at a low rate (3-5%) after IVIG and high-dose ASA treatment. The aim of this study was to determine the clinical and laboratory characteristics of patients diagnosed with Kawasaki disease by the pediatric cardiology clinic and to determine the risk factors for coronary artery involvement. Objective: The aim of this study is to determine the clinical and laboratory characteristics of patients diagnosed with Kawasaki disease in the pediatric cardiology department of Ege University Faculty of Medicine and to determine the risk factors for coronary artery involvement. Method: The study was carried out retrospectively by demographic, laboratory and electrocardiographic data of 100 cases followed by the diagnosis of Kawasaki disease between January 2013 and August 2019 by Ege University Faculty of Medicine Hospital, Department of Pediatric Cardiology. Results: The clinical and laboratory findings and follow-up results of 100 cases diagnosed with Kawasaki disease were evaluated. Sixty-two of the cases were male and 38 were female (Male / Female ratio was 1.6). The mean age of the patients was 2.8 ± 1.6 years, with seven patients under five years of age. 37 patients (37%) were diagnosed in the spring, 30 (30%) in the winter, 20 (20%) in the summer, and 13 (13%) in the autumn. While fever was completely present, there were 63 (63%) of the oropharyngeal mucosa, 60 (60%) of the lymphadenopathy Some, 47 (47%) of the polymorphic exanthema, 43 (43%) of the conjunctival congestion and 29 (29%) of the hands were present. Echocardiographic examination revealed 58 (58%) design coronary artery involvement, 4 (4%) menstrual coronary artery aneurysm and 38 (38%) history of coronary involvement. Of the patients with coronary artery involvement, 19 (32%) were female and 39 (68%) were male, without coronary artery involvement (32%) 18 (47%) were female and 20 (53%) were male; 1 (25%) of the patients with aneurysmatic coronary artery involvement were female and 3 (75%) were male. Age is 0-12 months, 20 years old, 10 of them have coronary involvement, 1 of them has aeurysmatic coronary artery involvement, 9 of them have no coronary involvement. Of 73 patients aged 13-60 months, 40 had coronary involvement, 3 had aeurysmatic coronary artery involvement, and 30 had no coronary involvement. All 7 patients with age> 60 months had coronary artery involvement. Aneurysmatic coronary artery involvement was detected in 4 patients at the time of diagnosis and in 1 month, in 3 patients in 6 months and in 1 patient in 1 year. Coronary artery involvement was detected in 58 patients at the time of diagnosis, while 25 patients in 1 month, 6 patients in 6 months and 1 year had coronary involvement. At the time of diagnosis, 38 patients had no coronary artery involvement. Echocardiography was normal in 85 patients at 6 months and 87 patients at 1 year. LCA was affected in 21 (21%) patients, RCA was affected in 10 (10%), and RCA and LCA were affected in 31 (31%) patients. Coronary artery involvement was not observed in 38 (38%) patients. The mean length of hospital stay was 14.2 days in children with coronary artery aneurysm, 11.9 days in children with coronary artery involvement, and 8.3 days in children without coronary artery involvement. Anemia (hematocrit <35%) in 90 (90%) patients, high erythrocyte sedimentation rate (> 20 mm / h) in 94 (94%), and CRP (83%) in 83 (83%) patients were evaluated by hematological and biochemical laboratory data. 3 mg / dl), thrombocytosis in 62 (62%) patients (platelet count> 350000), leukocytosis in 69 (69%) patients (white cell count> 12,000 / mm3), hypoalbuminemia in 82 (82%) patients (albumin <3.5 g / dl), hyponatremia (Na <135 mmol / L) in 29 (29%) patients and transaminase elevation in 18 (18%) patients. Complete urine analysis was found to be normal in 91 (91%) patients and leukocyturia was found in 9 (9%) patients. ECG pathology was seen in only 2 of 58 patients with coronary involvement and sinus tachycardia was detected in only one patient without coronary involvement. ECG pathology was not seen in aneurysmatic cases. Infiltration in POAG was detected in 4 of the patients with coronary artery involvement but PAAG pathology was not seen in patients without coronary artery involvement and aneurysmatic coronary artery involvement. Platelet elevation (> 350.000 / mm3) was detected in 62 patients at the time of diagnosis. On the 15th day, platelet elevation was observed in 49 patients with coronary involvement, in 4 patients with aneurysmatic coronary artery involvement and in 33 patients without coronary artery involvement. Platelet elevation was detected in 30 patients with coronary involvement, in 4 patients with aneurysmatic coronary artery involvement and in 23 patients without coronary artery involvement. In the 15th day control, the highest value was found to be 1.030.000 / mm3. In the first month, the highest value was recorded as 731.000 / mm3. Conclusion: Good diagnosis of Kawasaki disease may prevent the development of serious cardiovascular complications by providing early diagnosis and treatment of patients. Key words: Kawasaki Disease, Coronary artery involvement, Ege University