PMID- 30611297 OWN - NLM STAT- MEDLINE DCOM- 20190111 LR - 20200225 IS - 1546-0096 (Electronic) IS - 1546-0096 (Linking) VI - 17 IP - 1 DP - 2019 Jan 5 TI - Kawasaki disease shock syndrome: clinical characteristics and possible use of IL-6, IL-10 and IFN-gamma as biomarkers for early recognition. PG - 1 LID - 10.1186/s12969-018-0303-4 [doi] LID - 1 AB - BACKGROUND: As an acute febrile and inflammatory disease, Kawasaki disease (KD) could develop Kawasaki disease shock syndrome (KDSS) sometimes. However its pathogenesis was still not well known. This study was to learn more about the clinical features and evaluate the role of cytokines in the pathogenesis of KDSS. METHODS: We collected clinical and laboratory data retrospectively for all patients with KDSS(KDSS, n = 27)who were hospitalized at our hospital from Jan 2014 to Oct 2017. For patient with KDSS, we randomly identified 43 patients with KD as control subjects (KD, n = 43). Clinical features, laboratory evaluations were collected. Cytokines IL-2, IL-4, IL-6, IL-10, TNF-alpha and IFN-gamma in serum were assayed using flow cytometric bead array. RESULTS: The patients with KDSS were older age (43.41 +/- 31.42 vs 28.81 +/- 21.51 months, P < 0.05), longer duration of fever (10.63 +/- 5.12 vs 6.98 +/- 2.45 days, P < 0.05), higher WBC count, neutrophils, CRP, ESR, PCT and D-dimer, and lower hemoglobin and albumin, more severe hyponatremia and hypokalemia, more refractory to IVIG therapy, more coronary artery abnormalities (CAAs), aseptic meningitis, and longer duration of hospitalization than patients with KD (all P < 0.05). The levels of serum IL-6 [184.1 (27.7-2577.3) vs 54.1 (4-425) pg/ml], IL-10 [42.6 (5-236.7) vs 9.4 (3-94) pg/ml], TNF-alpha [2.6 (1.0-23.4) vs 2.1 (1-6) pg/ml] and IFN-gamma [18.3 (4.5-94.4) vs 6.7 (2-56) pg/ml] in KDSS patients were significant higher than KD patients (all P < 0.05). ROC curves showed that 66.7 pg/ml of IL-6, 20.85 pg/ml of IL-10 and 8.35 pg/ml of IFN-gamma had sensitivity and specificity for identifying KDSS as 85.2 and 62.8%; 66.7 and 83.7%; 74.1 and 74.4% respectively. No fatality was recorded in this series. CONCLUSIONS: KDSS were characteristic as more cytokine production and prone to developing IVIG non-responsiveness and CAAs. KD patients with IL-6 above 66.7 pg/ml, IL-10 above 20.85 pg/ml, and IFN-gamma above 8.35 pg/ml suggested higher risk for KDSS. FAU - Li, Yandie AU - Li Y AD - Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003, China. FAU - Zheng, Qi AU - Zheng Q AD - Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003, China. FAU - Zou, Lixia AU - Zou L AD - Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003, China. FAU - Wu, Jianqiang AU - Wu J AD - Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003, China. FAU - Guo, Li AU - Guo L AD - Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003, China. FAU - Teng, Liping AU - Teng L AD - Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003, China. FAU - Zheng, Rongjun AU - Zheng R AD - Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003, China. FAU - Jung, Lawrence Kwok Leung AU - Jung LKL AD - Division of Rheumatology, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA. FAU - Lu, Meiping AU - Lu M AUID- ORCID: 0000-0002-4930-9493 AD - Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Yan-an Road, Hangzhou, 310003, China. meipinglu@zju.edu.cn. LA - eng PT - Journal Article DEP - 20190105 PL - England TA - Pediatr Rheumatol Online J JT - Pediatric rheumatology online journal JID - 101248897 RN - 0 (Biomarkers) RN - 0 (Cytokines) RN - 0 (Immunoglobulins, Intravenous) SB - IM MH - Biomarkers/*blood MH - Child MH - Child, Preschool MH - Cytokines/*blood MH - Female MH - Flow Cytometry MH - Humans MH - Immunoglobulins, Intravenous/administration & dosage MH - Infant MH - Male MH - Mucocutaneous Lymph Node Syndrome/*complications/diagnosis/therapy MH - ROC Curve MH - Retrospective Studies MH - Shock/diagnosis/*etiology/therapy PMC - PMC6321686 OTO - NOTNLM OT - Clinical features OT - Cytokines OT - Kawasaki disease OT - Shock COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: This study was approved by the Research Ethics Committees of the Children's Hospital Zhejiang University School of Medicine (2017-IRB-021). CONSENT FOR PUBLICATION: All patients and their parents provided written informed consent for their data to be used in analyses and reported. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2019/01/07 06:00 MHDA- 2019/01/12 06:00 PMCR- 2019/01/05 CRDT- 2019/01/07 06:00 PHST- 2018/12/10 00:00 [received] PHST- 2018/12/19 00:00 [accepted] PHST- 2019/01/07 06:00 [entrez] PHST- 2019/01/07 06:00 [pubmed] PHST- 2019/01/12 06:00 [medline] PHST- 2019/01/05 00:00 [pmc-release] AID - 10.1186/s12969-018-0303-4 [pii] AID - 303 [pii] AID - 10.1186/s12969-018-0303-4 [doi] PST - epublish SO - Pediatr Rheumatol Online J. 2019 Jan 5;17(1):1. doi: 10.1186/s12969-018-0303-4.