30 - KAWASAKI DISEASE SHOCK SYNDROME VERSUS SEVERE MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN: TAIWAN'S PERSPECTIVES

Background:  

Multisystem Inflammatory Syndrome in Children (MIS-C) is a systemic inflammatory disorder characterized by Kawasaki disease-like features with multi-organ dysfunction in children following COVID-19 viral infection. In Taiwan, shock manifested in around 38.6% of patients with MIS-C, exceeding the incidence (1.34%) observed in Kawasaki disease shock syndrome. This study was aimed to compare clinical manifestations in KDSS and severe MIS-C in Taiwan. 

Methods:  

Patients with severe MIS-C and KDSS admitted at the National Taiwan University Children's Hospital were retrospectively enrolled. A comparative analysis was conducted to delineate the differences between severe MIS-C and Kawasaki disease shock syndrome. Clinical manifestations, including laboratory data, echocardiography, treatment regimen, and outcomes, were analyzed.

Results:  

A total of 33 children meeting the Taiwan CDC criteria for MIS-C and presenting with shock were included in the study. Additionally, 23 patients with KDSS were enrolled. The median age of KDSS patients was 2.3 years, younger than those with severe MIS-C (p=0). The duration of fever before admission in KDSS patients was longer than in severe MIS-C (p=0.024), with no significant differences in the length of hospitalization or fever. Concerning Kawasaki disease symptoms, KDSS patients exhibited a higher incidence of edematous changes in extremities (p=0.003) and BCG scar redness (p=0.015). Severe MIS-C patients had a higher proportion of gastrointestinal symptoms than KDSS patients. KDSS patients demonstrated a higher white blood cell count (p=0), higher platelet count (p=0), and lower hemoglobin (p=0) compared to severe MIS-C patients. Both KDSS and severe MIS-C patients had elevated CRP levels (p=0.717), with KDSS patients exhibiting a lower albumin level (p=0.035) than MIS-C patients. While the median pro-BNP level in KDSS patients was higher than in severe MIS-C patients, the difference was not statistically significant. Among patients who underwent echocardiographic examination in the acute phase, a higher percentage of KDSS patients had decreased left ventricular systolic function than severe MIS-C patients (30.9% vs 9.6%). Notably, coronary artery lesions (maximal coronary Z-score > +2.5) were observed in 30% of KDSS patients, a rate higher than the 8% observed in severe MIS-C patients. However, this difference did not achieve statistical significance.

Conclusion:  

Severe MIS-C shares certain features with KDSS. In contrast to severe MIS-C, patients with KDSS presented with significant differences in counts of leukocytes and platelets, and levels of hemoglobin and albumin. Additionally, KDSS was associated with a higher proportion of positive BCG red halo, decreased left ventricular systolic function and coronary artery lesions.