Evaluation of Clinical, Laboratory Findings and Prognosis in Kawasakı Patients

Öz

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.

Anahtar Kelimeler

• Aneurysm
• kawasaki
• strawberry tongue
• fever
• proBNP

Kawasaki Hastalarında Klinik, Laboratuvar Bulguların ve Prognozun Değerlendirilmesi

Öz

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.

Anahtar Kelimeler

• Anevrizma
• kawasaki
• çilek dili
• ateş
• proBNP

Kaynakça

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