Retrospective evaluation of the effect of clinical and laboratory findings and hematological parameters on clinical picture in patients WHO are being followed up with A diagnosis of kawasaki disease

Objective: Kawasaki disease is a vasculitis that is characterized by acute fever in children. The disease is a significant cause of morbidity and mortality especially because of its effects on the coronary arteries. Presence of clinical and laboratory parameters, which could indicate the disease and its course, is needed, because the diagnosis is made with clinical findings, and diagnostic delay increases mortality and morbidity. In our study, we aimed to find clues, which could detect the disease in the early period, and specify the variables, which indicate the prognosis, by evaluating the relationship of clinical, laboratory and echocardiographic findings with each other. Material and Method: Seventy two patients who were followed up between January 2011 and January 2021 at Bezmialem Foundation University Hospital, Department of Pediatrics with a diagnosis of Kawasaki disease, who did not have other comorbidities, and 72 healthy children, who did not have any chronic disease and febrile illness in the last 15 days, were included in the study. The patients' demographic, clinical, laboratory, echocardiographic and abdominal USG findings, and the complications of the disease were examined from electronic file records. The patient groups who had complete and incomplete kawasaki disease, who did and did not have cardiac involvement, who did and did not have coronary artery involvement, and who did and did not have IVIG resistance were compared in terms of laboratory findings, incidence, age, sex and clinical findings. NLR, PLR, LMR, MPV/L, MPV/PDW, MPV/PC, Hb/RDW, AST/ALT, Fibrinogen/Albumin, CRP/Albumin ratios obtained from the laboratory tests, were compared between these groups. Age, sex and hemogram parameters and the NLR, PLR, LMR, MPV/L, MPV/PDW, MPV/PC, Hb/RDW ratios were compared between all patients and the control group. All statistical analyses were performed using R sofware (version 4.2.0). Rstatix v0.7.0 and gtsummary v1.6.0 packages were used in statistical analyses. Compatibility of the variables to normal distribution was tested using the Shapiro Wilk test and Q-Q plot and histogram graphs. The continuous data were analysed using the Mann Whitney U and Student's t-test for independent groups and Wilcoxon test and student's t-test for dependent groups. For categorical data, the Pearson chi-square test was used when the number of observations was sufficient, and the Fisher's exact test was used when the number of observations was insufficient. Results: In our study, the male/female ratio was 1:1. The patients' ages ranged between 1,5 months and 142 months. The mean age was 39,6±30,9 months and the median age was 30 (19-56.2) months. In our study, 16,7% of the patients were under the age of 1 year, and 78% were under the age of 5 years. When the distributions of the clinical characteristics, which are the diagnostic criteria for Kawasaki disease, were evaluated, it was found that oropharyngeal findings were the most common findings and erythema and edema on bilateral hands and feet were the least common finding. When the patient group and control group were compared in terms of laboratory parameters, it was found that WBC, neutrophil count, monocyte count, RDW, PLT, MPV, Platelitcrit, NLR, PLR, MPV/L, MPV/PDW ratio were found to be statistically significantly higher in the patient group compared to the control group. The lymphocyte count, Hemoglobin, Hematocrit, PDW, LMR, Hb/RDW ratio were found to be statisticaly significantly lower in the patient group compared to the control group (p<0,01). When the laboratory parameters on the day of diagnosis (the 0th day) and the laboratory parameters 10 days after the diagnosis were compared in the patients with Kawasaki disease, it was found that WBC (p<0,01), neutrophil count (p<0,01), monocyte count (p=0,09), MPV (p<0,01), CRP (p<0,01), ESR (p<0,01), NLR (p<0,01), PLR (p=0,021), MPV/L (p<0,01), MPV/PC (p<0,01) and hemoglobin/RDW ratio (p=0,02) on the 0th day were statistically significantly higher and Lymphocyte (p<0,01), RDW (p<0,01), Platelet (p<0,01), Plateletcrit (p<0,01), LMR (p<0,01) on the 0th day were lower compared to the measurements after the 10th day. Incomplete Kawasaki disease was found in 38.9% of the patients. When the laboratory findings were compared between complete and incomplete Kawasaki patients, ESR was found to be statistically significantly higher in the patients who had incomplete Kawasaki disease (p=0.048). The neutrophil/lymphocyte ratio was found to be statistically significantly lower in the incomplete Kawasaki group (p=0.040). The blood tests, which were obtained on the 10th day of the diagnosis or afterwards, were compared in the complete and incomplete Kawasaki patients. In the incomplete Kawasaki group, RDW, MPV and the MPV/PDW ratio were found to be statistically significantly higher (p<0,05). When the differences between the laboratory parameters on the day of diagnosis and the laboratory parameters after the 10th day (the value after the 10th day- the value on the 0th day) were compared in the complete and incomplete Kawasaki groups, the difference in PDW was statistically significantly higher and the difference in NLR, PLR and MPV/PDW ratio was statistically significantly lower in the incomplete Kawasaki group compared to the complete Kawasaki group (p<0,05). IVIG resistance was present in 20,8% of the patients. Five (33%) of the patients, who had IVIG resistance, were under the age of 1 year. In the group, who did not have IVIG resistance,5 patients (12%) were under the age of 1 year. When the patients' clinical characteristics were evaluated by IVIG resistance, it was found that fever-IVIG duration, hospitalization period, rate of hospitalization in pediatric intensive care unit and rate of hepatomegaly were statistically significantly higher in the group who had IVIG resistance compared to the group who did not have IVIG resistance. When the laboratory results obtained at the time of diagnosis were evaluated, PDW was found to be statistically significantly lower in the group who had IVIG resistance compared to the group who did not have IVIG resistance. When the patients' laboratory parameters and ratios tested after the 10th day of diagnosis were compared by IVIG resistance, the monocyte count, CRP, ESR, MPV/PDW ratio were found to be statistically significantly higher in the group who had IVIG resistance compared to the group who did not have IVIG resistance. The PDW value was statistically significantly lower in the group who had IVIG resistance compared to the group who did not have IVIG resistance. When the patients' echocardiographic findings were examined, it was found that 24 patients (33,3%) had cardiac involvement. In the patient group who had cardiac involvement, 8 patients (33,3%) had increased echogenicity in the coronary arteries, 9 patients (37,5%) had coronary artery dilatation, 5 patients (21%) had mitral insufficiency and 2 patients (8,3%) had coronary artery aneurysm. Coronary artery involvement was observed in 15,3% of all patients. Coronary artery dilatation was observed in 12,5% of all patients and coronary artery aneurysm was observed in 2,8%. When the groups with and without cardiac involvement were compared in terms of laboratory characteristics, it was found that the RDW value was statistically significantly higher (p=0.043), and the Hb/RDW (p=0,038) value and creatinine kinase value (p=0,035) were lower in the group with cardiac involvement compared to the group without cardiac involvement. The median fever-diagnostic suspicion duration was 10 (6-12,5) days in the patients who had coronary artery involvement and 6 (5-8) days in the patients who did not have coronary artery involvement. In our study, it was found that the diagnosis was suspected significantly later in the patients who had coronary involvement compared to the patients who did not have coronary involvement. The neutrophil, hemoglobin, hematocrit, Hb/RDW and platelet values were found to be statistically significantly lower and the median RDW value and the MPV/PC ratio were found to be higher in the patients who had coronary artery involvement compared to the patients who did not have coronary artery involvement. Among 32 patients whose viral serology data could be reached, 8 (25%) patients were found to be positive. In this patient group, 3 patients (37,5% of the positive patients) were parvovirus positive, 2 patients (25%) were CMV positive, 1 patient (12,5%) was EBV positive, 1 patient (12,5%) was influenza A positive and 1 patient (12,5%) was mumps virus positive. Conclusion: Our patients' clinical findings are compatible with the literature, and it is important to predict coronary artery involvement, because this complication occurs frequently. In our study, comparisons were made between the Kawasaki patients and healthy controls, between the patients who did and did not have coronary involvement, between the patients who did and did not have IVIG resistance and between the comlete and incomplete Kawasaki patients.We concluded that some hematological parameters such as NLR, PLR, LMR, MPV/L, MPV/PDW, MPV/PC, Hb/RDW, some of which had never been studied before in these patient groups, might have a contribution in predicting the disease, clinical course and prognosis. Key words: Kawasaki disease, cardiovascular complications, neutrophil/ lymphocyte ratio, platelet/ lymphocyte ratio, Hb/RDW ratio