To compare the clinical features and resuscitative measures of children with Kawasaki disease shock syndrome versus septic shock.
In this retrospective case-control study, children with KDSS admitted to the intensive care unit from 2007 to 2017 were identified and compared with age-matched controls with septic shock. We studied 9 children with KDSS and 18 children with septic shock. Clinical characteristics were abstracted and between-group differences were compared.
Compared with septic shock controls, children with KDSS were less likely to have an underlying comorbid illness (1/9 (11%) vs 11/18 (61%), P = .02) and were more likely to have at least one of the five classic diagnostic signs of KD at presentation (9/9 (100%) vs. 0/18 (0%), p<0.001), a longer duration of illness pre-admission (9 (IQR 7,14) days vs. 3 (IQR 1,5) days, p=0.004), and a lower platelet count at presentation (140 (IQR 73, 167) vs. 258 (IQR 137, 334), p=0.02). Among subjects who underwent echocardiography, abnormalities such as ventricular dysfunction, valvulitis, and coronary artery dilation were more common in the KDSS cohort (5/9 (56%) vs. 0/7 (0%), p=0.03). There were no differences in volume of fluid resuscitation, vasoactive-inotropic scores, duration of inotropic therapy, or biochemical markers of illness severity (other than platelet count) between the matched groups.
Longer duration of illness pre-admission, lack of significant underlying medical comorbidities, lower platelet count, echocardiographic abnormalities, and presence of classic diagnostic signs of KD at presentation may be useful early features to differentiate KDSS from septic shock.

Copyright © 2020. Published by Elsevier Inc.