Ortiz-Espinosa de los Monteros AP, Rendón-Macías ME, Silva-Ramírez H, Domínguez-Barbosa VP, Ortiz-López BD

Language: Spanish
References: 15
Page: 154-159
PDF size: 832.72 Kb.

ABSTRACT

Introduction: Kawasaki disease (KD) is a systemic vasculitis with a variable clinical course; some patients require prolonged hospital stays, possibly related to a more severe inflammatory process. Objective: to identify the clinical, laboratory, and therapeutic characteristics associated with prolonged hospital stay in pediatric patients with KD. Material and methods: an observational, analytical, and retrospective study conducted at a private hospital in Mexico City. Patients with KD disease treated between 2021 and 2025 were included. Clinical, laboratory, and therapeutic variables were compared between patients with short (1-5 days) and prolonged (≥ 6 days) hospital stays. Results: forty-three patients were included, with a median age of six years; 24 (55.8%) were male. At the time of hospital admission, patients with a prolonged hospital stay more frequently presented with extremity edema, higher serum ferritin concentrations, lower platelet counts, and more prolonged prothrombin times. Likewise, these patients required more frequently corticosteroids and a second dose of immunoglobulin. Conclusions: the presence of limb edema and elevated serum ferritin concentrations was associated with a prolonged hospital stay. These findings suggest that identifying certain clinical and laboratory characteristics at the time of hospital admission may help identifyed patients requiring closer monitoring.

REFERENCES

1. McCrindle BW, Rowley AH, Newburger JW et al. Diagnosis,treatment, and long-term management of Kawasaki disease: ascientific statement for health professionals from the AmericanHeart Association. Circulation. 2017; 135(17): e927-e999. doi:10.1161/CIR.0000000000000484.

2. Jone PN, Tremoulet A, Choueiter N et al. Update on diagnosisand management of Kawasaki disease: a scientific statementfrom the American Heart Association. Circulation. 2024; 150(23):e481-e500. doi: 10.1161/CIR.0000000000001295.

3. Makino N, Nakamura Y, Yashiro M et al. Epidemiologicalobservations of Kawasaki disease in Japan, 2013-2014. PediatrInt. 2018; 60(6): 581-587. doi: 10.1111/ped.13544.

4. Narayan HK, Lizcano A, Lam-Hine T et al. Clinical presentation andoutcomes of Kawasaki disease in children from Latin America: amulticenter observational study from the REKAMLATINA Network.J Pediatr. 2023; 263: 113346. doi: 10.1016/j.jpeds.2023.02.001.

5. Day-Lewis M, Son MBF, Lo MS. Kawasaki disease: contemporaryperspectives. Lancet Child Adolesc Health. 2024; 8(10): 781-792.doi: 10.1016/S2352-4642(24)00169-X.

6. Burns JC, Roberts SC, Tremoulet AH et al. Infliximab versus secondintravenous immunoglobulin for treatment of resistant Kawasakidisease in the USA (KIDCARE): a randomised, multicentrecomparative effectiveness trial. Lancet Child Adolesc Health. 2021;5(12): 852-861. doi: 10.1016/S2352-4642(21)00270-4.

7. Zou S, Hu B. Prevalence of intravenous immunoglobulin resistancein Kawasaki disease: a systematic review and meta-analysis. FrontPediatr. 2025; 13: 1566590. doi: 10.3389/fped.2025.1566590.

8. Wen H, Hun M, Zhao M, Han P, He Q. Serum ferritin as acrucial biomarker in the diagnosis and prognosis of intravenousimmunoglobulin resistance and coronary artery lesions in Kawasakidisease: a systematic review and meta-analysis. Front Med(Lausanne). 2022; 9: 941739. doi: 10.3389/fmed.2022.941739.

9. Liu Z, Jia W, Li P, Song C. Clinical value of combined detectionof serum ferritin and N-terminal pro-brain natriuretic peptide in theassessment of Kawasaki disease in children over 1 year of age.Ital J Pediatr. 2025; 51: 229. doi: 10.1186/s13052-025-02076-7.

10. Zhao J, Xu Y, Shi C et al. Expression of serum ferritin, humanneutrophil lipocalin, procalcitonin, and inflammatory factors inchildren with Kawasaki disease and their relationship to coronaryartery lesions. Am J Transl Res. 2025; 17(1): 286-293. doi:10.62347/MIHQ2583.

11. Zhang Y, Jia C, Guo M et al. Platelet-monocyte aggregate instigatesinflammation and vasculopathy in Kawasaki disease. Adv Sci(Weinh). 2025; 12: e2406282. doi: 10.1002/advs.202406282.

12. Hatano S, Nakao H, Masuda H, Ono H, Kubota M, Ishiguro A. Effectof additional intravenous immunoglobulin for infliximab-refractoryKawasaki disease: a cohort study. Pediatr Rheumatol Online J.2025; 23: 49. doi: 10.1186/s12969-025-01108-0.

13. Kim TH, Son Y, Lee H et al. Biomarkers and related factors forthe diagnosis, risk of coronary artery lesions, and resistance tointravenous immunoglobulin in Kawasaki disease: an umbrellareview of meta-analyses. Pediatr Cardiol. 2025; 46(6): 1488-1504.doi: 10.1007/s00246-024-03563-0.

14. Guo MM, Kuo HC. Promising biomarkers of Kawasaki disease:markers that aid in diagnosis. Expert Rev Mol Diagn. 2024: 1-13.doi: 10.1080/14737159.2024.2432025.

15. Kumrah R, Goyal T, Rawat A, Singh S. Markers of endothelialdysfunction in Kawasaki disease: an update. Clin Rev AllergyImmunol. 2024; 66(1): 99-111. doi: 10.1007/s12016-024-08985-5.