Lin Ying-Jui, Lin I-Chun, Yu Hong-Ren, Kuo Hsuan-Chang, Yang Kuender D, Chang Wei-Chiao, Liang Chi-Di, Liu Shih-Feng, Kuo Ho-Chang
Division of Cardiology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niaosung, Kaohsiung, Taiwan.
Pediatr Cardiol. 2013 Feb;34(2):250-5. doi: 10.1007/s00246-012-0429-y. Epub 2012 Jul 19.
Kawasaki disease (KD) is a systemic vasculitis and primarily affects children <5 years of age. Intensive care unit (ICU) admission is unusual, but there can be associated severe complications in KD patients. This study was conducted to identify risk factors for ICU admission. Retrospectively, we reviewed charts of all children who had a discharge diagnosis of KD from 2001 through 2009. Clinical presentation, laboratory data, and outcome were collected for analysis of the association with ICU admission in KD patients. Multifactor dimensionality reduction (MDR) was used to identify factor interactions. There were 334 KD patients, including 24 patients in ICU admission, included in the analysis. Coronary artery lesions (CALs) and failure of intravenous immunoglobulin (IVIG) treatment were more frequently found in the ICU group (P < 0.0001). Total counts of white blood cells, hemoglobin levels, C-reactive protein, and albumin levels showed significant association with ICU admission (P < 0.05). Moderate tricuspid regurgitation (TR) was found only in the ICU admission group. MDR analyses of factor interactions identified that TR interacted with CAL with a prediction accuracy of 77.78 %. (P = 0.001). Patients with KD who are IVIG resistant and/or who are found to have CALs are at increased risk for ICU admission. Most importantly, moderate TR was significantly found in KD patients only in the ICU group. This may highlight the great value of moderate TR in predicting ICU admission for patients with KD.
川崎病（KD）是一种全身性血管炎，主要影响5岁以下儿童。入住重症监护病房（ICU）的情况并不常见，但KD患者可能会出现严重并发症。本研究旨在确定入住ICU的危险因素。我们回顾性分析了2001年至2009年所有出院诊断为KD的儿童病历。收集临床表现、实验室数据及转归情况，以分析与KD患者入住ICU的相关性。采用多因素降维法（MDR）确定因素间的相互作用。分析纳入334例KD患者，其中24例入住ICU。ICU组冠状动脉病变（CALs）及静脉注射免疫球蛋白（IVIG）治疗失败更为常见（P<0.0001）。白细胞总数、血红蛋白水平、C反应蛋白及白蛋白水平与入住ICU显著相关（P<0.05）。仅在入住ICU组发现中度三尖瓣反流（TR）。MDR分析因素间相互作用发现，TR与CAL相互作用，预测准确率为77.78%（P=0.001）。IVIG抵抗和/或有CALs的KD患者入住ICU的风险增加。最重要的是，仅在ICU组的KD患者中显著发现中度TR。这可能凸显了中度TR在预测KD患者入住ICU方面的巨大价值。
