Yan Jia-Huei, Chang Ling-Sai, Lin Yi-Ju, Guo Mindy Ming-Huey, Huang Ying-Hsien, Kuo Ho-Chang
Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Front Pediatr. 2020 May 5;8:221. doi: 10.3389/fped.2020.00221. eCollection 2020.
Kawasaki disease (KD) is a form of vasculitis that primarily affects children under the age of 5 years old. Patients may be missed or diagnosis delayed when initial clinical symptoms do not fulfill the traditional criteria or a normal echocardiography was found. In this study, we aimed to analyze factors that clinicians could use to differentiate febrile children suspected of KD. We retrospectively enrolled in this study a total of 50 febrile children who were initially suspected of KD, but they did not meet the American Heart Association (AHA) criteria for a diagnosis. However, some of these patients were diagnosed with KD during their second visit. We analyzed patients' characteristics, clinical symptoms, and laboratory data (initial data in the first visit). In total, 50 patients were enrolled in the study. Of those, ten patients were diagnosed with KD on their second visit (group 1), while the other 40 patients still did not fit a KD diagnosis (group 2). A higher neutrophil-to-lymphocyte ratio (NLR, = 0.037) and higher C-reactive protein levels (CRP, = 0.02) were found in group 1 when compared to group 2. A patient with a NLR >1.33 combined with a CRP more than 33 mg/L was more likely to have KD (Sensitivity 90%, specificity 69.2%, = 0.001; Odds ratio 20.25, 95% confident interval 2.3-178.25). Among patients suspected of KD that did not initially meet the criteria, clinicians should pay special attention to elevated neutrophil-to-lymphocyte ratios and CRP levels and closely follow up such patients.
川崎病（KD）是一种血管炎，主要影响5岁以下儿童。当初始临床症状不符合传统标准或超声心动图正常时，患者可能会被漏诊或诊断延迟。在本研究中，我们旨在分析临床医生可用于鉴别疑似KD的发热儿童的因素。我们回顾性纳入了50名最初疑似KD但不符合美国心脏协会（AHA）诊断标准的发热儿童。然而，其中一些患者在第二次就诊时被诊断为KD。我们分析了患者的特征、临床症状和实验室数据（首次就诊时的初始数据）。总共50名患者纳入了研究。其中，10名患者在第二次就诊时被诊断为KD（第1组），而其他40名患者仍不符合KD诊断（第2组）。与第2组相比，第1组的中性粒细胞与淋巴细胞比值更高（NLR，P = 0.037），C反应蛋白水平更高（CRP，P = 0.02）。NLR>1.33且CRP超过33mg/L的患者更有可能患有KD（敏感性90%，特异性69.2%，P = 0.001；优势比20.25，95%置信区间2.3 - 178.25）。在最初不符合标准的疑似KD患者中，临床医生应特别关注升高的中性粒细胞与淋巴细胞比值和CRP水平，并密切随访此类患者。
