Significance of hyponatremia in Kawasaki disease

Tsuji, Shoji

doi:10.1111/ped.14169

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…PNI was also demonstrated to be correlated with disease activity in patients with systemic lupus erythematosus [25,26]. Besides, several previous studies reported that hyponatremia was observed in children with KD, particularly children with IVIG resistant KD [27][28][29] and was associated with the extent of inflammation [30,31]. In line with these studies, low PNI was demonstrated to be closely associated with low serum sodium in the present study.…”

Section: Discussionsupporting

confidence: 89%

Value of pretreatment prognostic nutritional index in predicting intravenous immunoglobin-resistant Kawasaki disease

Chen

et al. 2020

Preprint

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Background: The aim of the present study was to investigate the potential predictive significance of pretreatment prognostic nutritional index (PNI) in patients with intravenous immunoglobulin (IVIG) resistant Kawasaki disease (KD). Methods: From June 2013 to May 2020, 1,257 eligible patients with KD were included in the present study. The pretreatment PNI was calculated as albumin level (g/L) +5×total lymphocyte count (109/L). The optimal cut-off values for PNI, neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) were evaluated via a receiver operating curve analysis. The impact of pretreatment PNI, NLR and PLR for IVIG resistant KD were tested with the Student's t test or Mann-Whitney U test, and univariate and multivariate analyses. Results: The optimal cut-off values were identified as 49.50 for PNI, 3.58 for NLR and 164.00 for PLR, respectively. Lower pretreatment PNI levels were demonstrated to be associated with lower age, serum sodium levels and platelet counts, and with a higher incidence of IVIG resistance and higher C-reactive protein levels. There was a significantly negative association between the PNI and NLR, and PLR. In the logistic analyses, PNI as independent predictive factors were significantly correlated with IVIG resistance. The discriminatory ability of PNI was not inferior to NLR and PLR for predicting IVIG resistance. Conclusion: Pretreatment PNI could serve as a novel surrogate independent predictor for patients with IVIG resistant KD.

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Section: Discussionsupporting

confidence: 89%

Value of pretreatment prognostic nutritional index in predicting intravenous immunoglobin-resistant Kawasaki disease

Chen

et al. 2020

Preprint

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“…The conditions of patients with KD and hyponatremia are generally more serious than those of patients without hyponatremia. In particular, in terms of the incidence of coronary artery lesions, the odds ratio of patients with KD with versus without hyponatremia was as high as 4.78 ( 19 ). These electrolyte disorders may further affect cardiovascular function, aggravate shock symptoms, and even be life-threatening in severe cases.…”

Section: Discussionmentioning

confidence: 99%

Predicting Kawasaki disease shock syndrome in children

Zhao,

Yuan,

Gao

et al. 2024

Front. Immunol.

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BackgroundKawasaki disease shock syndrome (KDSS) is a critical manifestation of Kawasaki disease (KD). In recent years, a logistic regression prediction model has been widely used to predict the occurrence probability of various diseases. This study aimed to investigate the clinical characteristics of children with KD and develop and validate an individualized logistic regression model for predicting KDSS among children with KD.MethodsThe clinical data of children diagnosed with KDSS and hospitalized between January 2021 and December 2023 were retrospectively analyzed. The best predictors were selected by logistic regression and lasso regression analyses. A logistic regression model was built of the training set (n = 162) to predict the occurrence of KDSS. The model prediction was further performed by logistic regression. A receiver operating characteristic curve was used to evaluate the performance of the logistic regression model. We built a nomogram model by visualizing the calibration curve using a 1000 bootstrap resampling program. The model was validated using an independent validation set (n = 68).ResultsIn the univariate analysis, among the 24 variables that differed significantly between the KDSS and KD groups, further logistic and Lasso regression analyses found that five variables were independently related to KDSS: rash, brain natriuretic peptide, serum Na, serum P, and aspartate aminotransferase. A logistic regression model was established of the training set (area under the receiver operating characteristic curve, 0.979; sensitivity=96.2%; specificity=97.2%). The calibration curve showed good consistency between the predicted values of the logistic regression model and the actual observed values in the training and validation sets.ConclusionHere we established a feasible and highly accurate logistic regression model to predict the occurrence of KDSS, which will enable its early identification.

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“…In addition, while MIS-C is a new phenomenon, physicians have noted clinical similarities between MIS-C and Kawasaki disease (KD) ( 18 ). The severity of KD demonstrates strong association with hyponatremia and meta-analysis of MIS-C studies reported hyponatremia was present in 80.8% of MIS-C patients ( 19 , 20 ). This meta-analysis aimed to determine the prevalence, outcomes and associated demographic and clinical variable in children with hyponatremia and COVID-19/MIS-C. We hypothesized that hyponatremia would be prevalent in pediatric patients with COVID-19 and MIS-C and would be associated with increased: length of stay (LOS), need for mechanical ventilation, and inflammatory markers at admission.…”

Section: Introductionmentioning

confidence: 99%

The prevalence and outcomes of hyponatremia in children with COVID-19 and multisystem inflammatory syndrome in children (MIS-C)

Dalal,

Pfaff,

Silver

et al. 2023

Front. Pediatr.

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IntroductionTo assess the prevalence of hyponatremia among pediatric patients with coronavirus disease 2019 (COVID-19) and Multisystem Inflammatory Syndrome in Children (MIS-C) and determine if pediatric hyponatremia was associated with an increased length of stay, higher rates of mechanical ventilation, and/or elevated inflammatory markers on admission as compared to eunatremic patients.MethodsElectronic health records were retrospectively analyzed for 168 children less than 18 years old with COVID-19 or MIS-C who were admitted to pediatric units within the Northwell Health system. The primary exposure was hyponatremic status (serum sodium <135 mEq/L) and the primary outcomes were length of stay, mechanical ventilation usage and increased inflammatory markers.ResultsOf the 168 children in the study cohort, 95 (56%) were admitted for COVID-19 and 73 (43.5%) for MIS-C. Overall, 60 (35.7%) patients presented with hyponatremia on admission. Patients with hyponatremia had higher rates of intensive care unit admission when compared to eunatremic patients (32/60 [53.3%] vs. 39/108 [36.1%], p = 0.030). In regression models, hyponatremia was not significantly associated with increased length of stay or mechanical ventilation rates. After adjustment for relevant confounders, hyponatremia remained associated with an increased square root CRP (β = 1.79: 95% CI: 0.22–3.36) and lower albumin levels (β = −0.22: 95% CI: −0.42–−0.01).ConclusionHyponatremia is common in pediatric COVID-19 and MIS-C. Hyponatremia was associated with a lower albumin and higher square root CRP levels. This may suggest an association of inflammation with lower serum sodium levels.

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Significance of hyponatremia in Kawasaki disease

Cited by 4 publications

References 5 publications

Value of pretreatment prognostic nutritional index in predicting intravenous immunoglobin-resistant Kawasaki disease

Value of pretreatment prognostic nutritional index in predicting intravenous immunoglobin-resistant Kawasaki disease

Predicting Kawasaki disease shock syndrome in children

The prevalence and outcomes of hyponatremia in children with COVID-19 and multisystem inflammatory syndrome in children (MIS-C)

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