Factors Associated with Shock at Presentation in Kawasaki Disease Versus Multisystem Inflammatory Syndrome in Children Associated with COVID-19

Supriya S. Jain, Department of Pediatrics, Division of Cardiology, New York Medical College-Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA. Electronic address: Sjain7@nymc.edu.
Ashraf S. Harahsheh, Division of Cardiology, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Simon Lee, The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
Geetha Raghuveer, Children's Mercy Hospital, Kansas City, MO, USA.
Nagib Dahdah, Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
Michael Khoury, Department of Pediatrics, University of Alberta. Edmonton, AB, Canada.
Michael A. Portman, Seattle Children's Research Institute, Seattle, WA, USA.
Melissa Wehrmann, Children's Nebraska, Omaha, NE, USA.
Arash A. Sabati, Phoenix Children's, Phoenix, AZ, USA.
Marianna Fabi, Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-universitaria di Bologna, 40138 Bologna, Italy.
Deepika Thacker, Nemours Children's Hospital, Delaware, Wilmington, DE, USA.
Nilanjana Misra, Northwell, New Hyde Park, Cohen Children's Medical Center, NY, USA.
Mark D. Hicar, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Nadine F. Choueiter, Children's Hospital at Montefiore, Bronx, NY, USA.
Matthew D. Elias, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Audrey Dionne, Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
William B. Orr, Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA.
Jacqueline R. Szmuszkovicz, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Seda Selamet Tierney, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA.
Luis Martin Garrido-Garcia, Hospital Angeles Lomas, Huixquilucan, Mexico / Instituto Nacional de Pediatria, Mexico City, Mexico.
Frederic Dallaire, Universite de Sherbrooke and Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada.
Balasubramanian Sundaram, Kanchi Kamakoti Childs Trust Hospital, Chennai, 600034, India.
Deepa Prasad, Banner Children's Hospital at Desert Medical Center, Mesa, AZ, USA.
Tyler H. Harris, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Elizabeth Braunlin, University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
Elisa Fernandez Cooke, Hospital Universitario 12 de Octubre, Madrid, Spain.
Cedric Manlhiot, Blalock-Taussig-Thomas Congenital Heart Center at Johns Hopkins University, Baltimore, MD, USA.
Pedrom Farid, Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
Brian W. McCrindle, Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.

Document Type

Journal Article

Publication Date

11-30-2024

Journal

The Canadian journal of cardiology

DOI

10.1016/j.cjca.2024.11.027

Abstract

BACKGROUND: While clinical overlap between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) has been evident, information regarding those presenting with shock has been limited. We sought to determine associations with shock within and between diagnosis groups. METHODS: The International KD Registry enrolled contemporaneous patients with either KD or MIS-C from 39 sites in 7 countries from 01/2020 to 01/2023. Demographics, clinical features and presentation, management, laboratory values, and outcomes were compared between the diagnosis/shock groups. RESULTS: Shock at presentation was noted for 19 of 672 (2.8%) KD patients and 653 of 1472 (44%; p<0.001) MIS-C patients. Within both groups, patients with shock were significantly more likely to be admitted to the intensive care unit, receive inotropes and to have greater laboratory abnormalities indicative of hyperinflammation and organ dysfunction, including abnormal cardiac biomarkers. Patients with KD and shock had a greater maximum coronary artery Z score (median +2.62) versus KD patients without shock (+1.36; p<0.001) and MIS-C patients with shock (+1.45; versus +1.32 for those without shock; p<0.001). They were also more likely to have large coronary artery aneurysms. In contrast, MIS-C patients with shock had lower left ventricular ejection fraction (mean 51.6%) versus MIS-C patients without shock (56.6%; p<0.001) and KD patients with shock (56.7%; versus 62.8% for those without shock; p=0.04). CONCLUSIONS: While patients with KD presenting with shock are clinically similar to patients with MIS-C, especially those with shock, they have more severe coronary artery involvement, while MIS-C patients with shock have lower left ventricular ejection fraction.

Department

Pediatrics

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