[Diagnosis and treatment of incomplete Kawasaki disease in children]

The association of serum CHI3L1 levels with the presence of Kawasaki disease

Chitinase 3-like protein 1(CHI3L1) has been found to be a biomarker for inflammatory diseases, but the diagnostic value of Kawasaki disease (KD) is not investigated. A total of 180 subjects, including 80 KD patients, 70 febrile controls and 30 healthy controls were recruited. Serum of CHI3L1 were measured with an enzyme-linked immunosorbent assay. The correlation between CHI3L1 and clinical parameters was assessed by Spearman correlation coefficient. Multiple logistic regression was employed to investigate the association between CHI3L1 and the incidence of KD. The diagnostic power was evaluated with the receiver operating characteristic curve analysis. Serum CHI3L1 levels in the KD group were significantly higher than those in the fever control group and healthy group. Compared with fever patients, both patients with incomplete KD and complete KD had higher serum CHI3L1 levels. Serum CHI3L1 levels were positively associated with white blood cell counts, neutrophils, platelet, erythrocyte sedimentation rate, C-reactive protein, alanine aminotransferase and the incidence of KD, and negatively associated with hemoglobin, aspartate aminotransferase and albumin. High CHI3L1 tertiles was significantly associated with the high incidence of KD in the unadjusted or adjusted models. Analysis of the Receiver operating characteristic curves, it was showed that the area under the curve was 0.908, with sensitivity of 0.838 and specificity of 0.8 for continuous CHI3L1, and was 0.884 for categorical CHI3L1, with sensitivity of 0.938 and specificity of 0.643 to distinguish all types of KD, respectively. CHI3L1 had the AUC of 0.901, with sensitivity of 0.826 and specificity of 0.8, and had the area under curve of 0.952, with sensitivity of 0.818 and specificity of 0.971 to discriminate complete KD and incomplete KD from febrile diseases, respectively. Serum of CHI3L1 may be a novel and reliable biomarker for the diagnosis of KD.

[Diagnosis of coronary artery lesions in children based on Z-score regression model]

OBJECTIVES

To construct a Z-score regression model for coronary artery diameter based on echocardiographic data from children in Sichuan Province and to establish a Z-score calculation formula.

METHODS

A total of 744 healthy children who underwent physical examinations at Sichuan Provincial People's Hospital from January 2020 to December 2022 were selected as the modeling group, while 251 children diagnosed with Kawasaki disease at the same hospital from January 2018 to December 2022 were selected as the validation group. Pearson correlation analysis was conducted to analyze the relationships between coronary artery diameter values and age, height, weight, and body surface area. A regression model was constructed using function transformation to identify the optimal regression model and establish the Z-score calculation formula, which was then validated.

RESULTS

The Pearson correlation analysis showed that the correlation coefficients for the diameters of the left main coronary artery, left anterior descending artery, left circumflex artery, and right coronary artery with body surface area were 0.815, 0.793, 0.704, and 0.802, respectively (P<0.05). Among the constructed regression models, the power function regression model demonstrated the best performance and was therefore chosen as the optimal model for establishing the Z-score calculation formula. Based on this Z-score calculation formula, the detection rate of coronary artery lesions was found to be 21.5% (54/251), which was higher than the detection rate based on absolute values of coronary artery diameter. Notably, in the left anterior descending and left circumflex arteries, the detection rate of coronary artery lesions using this Z-score calculation formula was higher than that of previous classic Z-score calculation formulas.

CONCLUSIONS

The Z-score calculation formula established based on the power function regression model has a higher detection rate for coronary artery lesions, providing a strong reference for clinicians, particularly in assessing coronary artery lesions in children with Kawasaki disease.

[Evidence-based guidelines for the diagnosis and treatment of Kawasaki disease in children in China (2023)]

Kawasaki disease (KD) is an acute self-limiting vasculitis, and it is the most common cause of acquired heart disease in children under 5 years old. One of the improvement goals in pediatric quality control work for the year 2023, as announced by the National Health Commission, is to reduce the incidence of cardiac events and KD-related mortality in children with KD. In order to standardize the diagnosis, treatment, and long-term management practices of KD in China, and effectively prevent and reduce the incidence of coronary artery lesions and long-term adverse effects, the guideline working group followed the principles and methods outlined by the World Health Organization and referenced existing evidence and experiences to develop the "Evidence-based guidelines for the diagnosis and treatment of Kawasaki disease in children in China (2023)". The guidelines address the clinical questions regarding the classification and definition of KD, diagnosis of different types of KD, treatment during the acute phase of KD, application of echocardiography in identifying complications of KD, and management of KD combined with macrophage activation syndrome. Based on the best evidence and expert consensus, 20 recommendations were formulated, aiming to provide guidance and decision-making basis for healthcare professionals in the diagnosis and treatment of KD in children.