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Clinical Efficacy of Stratified Management Protocol Using a Risk Prediction Model in Kawasaki Disease

중앙의대지 2018년 43권 1호 p.15 ~ 21
김유나, 이은혜, 고정희, 한미영,
소속 상세정보
김유나 ( Kim Yoo-Na ) - Kyung Hee University Hospital Department of Pediatrics
이은혜 ( Lee Eun-Hye ) - Kyung Hee University Hospital Department of Pediatrics
고정희 ( Ko Jeong-Hee ) - Kyung Hee University Hospital at Gangdong Department of Pediatrics
한미영 ( Han Mi-Young ) - Kyung Hee University Hospital Department of Pediatrics

Abstract


Purpose: Although Kawasaki disease (KD) is a leading cause of acquired heart disease in children, a universal treatment protocol has yet to be established. This study was conducted to investigate the clinical utility of risk prediction model in the stratified management protocol of KD patients.

Methods: Data of patients with KD were collected from two affiliated centers, Kyung Hee University Hospital and Kyung Hee University Hospital at Gangdong, from January 2015 to March 2017. Exclusion criteria were as follows: whose diagnosis was recurrent Kawasaki disease, who received initial therapy at other hospital, who were either younger than 100 days or older than six years (72 months), and who were lost to follow-up. Patients are designated into two groups (group A and B) depending on whether the Kobayashi risk stratification model was used. Demographic characteristics, lab data, and patient charts were reviewed, and serial echocardiography was performed. As a primary outcome, patients' coronary artery z-scores were calculated using the McCrindle method and compared. All data were compared using SPSS v. 24, and a p-value of <0.05 was considered statistically significant.

Results: After applying exclusion criteria, 98 patients were finally included. Demographic characteristics of sex, age, and laboratory data were not significantly different between the two groups, and there were no differences in fever duration and hospitalization period. However, group A had lower z-scores over time compared to group B, with statistically significant differences (p <0.05).

Conclusion: This study suggested that initial KD risk stratification may direct selective management protocol and reduce coronary artery complications. These findings may be useful to optimize the management and outcomes of patients with KD.

키워드

Coronary z-score; Kawasaki disease; Kobayashi; Risk prediction model

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