Research Article
Volume 5 Issue 8 - 2018
Incidence and Outcomes of Kawasaki Shock Syndrome in United States: 2004-2014
Hitesh Agrawal1*, Carolyn A Altman1, Thomas J Seery1, Marietta M De Guzman2, Andrea A Ramirez2 and S Kristen Sexson Tejtel1
1The Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
2Pediatric Rheumatology Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
*Corresponding Author: Hitesh Agrawal, Fellow, Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA.
Received: May 30, 2018; Published: July 09, 2018
Citation: Hitesh Agrawal., et al. “Incidence and Outcomes of Kawasaki Shock Syndrome in United States: 2004-2014”. EC Cardiology 5.8 (2018): 514-522.
Abstract
Background: A subset of Kawasaki disease (KD) patients present with hypotension and shock, referred to as Kawasaki shock syndrome (KDSS). Little is known about KDSS in the US population. We sought to determine the incidence, predictors and outcomes of KDSS.
Methods: Using the Pediatric Health Information Systems dataset from 1/2004-3/2014, KDSS was defined as patients with KD who received IVIG and fulfilled ≥ 1 criteria for either ICD-9 diagnostic codes for shock; procedural/medication code for infusion of vasopressors, intensive hemodynamic monitoring, cardiopulmonary resuscitation, mechanical ventilation, or mechanical circulatory support. Clinical outcomes, additional drug use, mortality and hospital charges were compared using Chi square tests. Multivariate logistic regression was used to determine predictors of KDSS.
Results: Altogether 14,871 patients were admitted with acute KD, of which 1739 (11.7%) fulfilled criteria for KDSS. The predictors of KDSS include older age at presentation, non-Hispanic origin, abdominal signs/symptoms, concomitant bacterial/viral infection, sepsis and myocarditis. Patients with KDSS had significantly longer length of stay, higher rates of ICU admission, hospital charges, cardiac/renal complications and mortality (P < 0.001). Interestingly, only 27% of these patients with KD shock were treated in an ICU setting. KDSS patients had significantly higher use of additional anti-platelets, anti-coagulants, steroids and other immune modulators, antiarrhythmics, vasopressors, and anti-microbials (P < 0.001).
Conclusions: In a multi-institutional US cohort, shock accompanies 11.7% of acute Kawasaki admissions. KDSS patients are more likely to have serious adverse outcomes including mortality, coronary arterial changes, myocardial infarction, heart/renal failure, arrhythmia, need for transcatheter interventions, mechanical circulatory support and additional medical therapy.
Keywords: Kawasaki Shock Syndrome; Kawasaki Disease; Intravenous Immunoglobulin; Intensive Care Unit
Copyright: © 2018 Hitesh Agrawal., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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