Biomarkers of intravenous immunoglobulin resistance and coronary artery lesions in Kawasaki disease.

BACKGROUND: Currently, there are no reliable indicators for predicting intravenous immunoglobulin resistance and coronary artery lesions in the early stage of Kawasaki disease. METHODS: A total of 300 patients with Kawasaki disease were studied retrospectively. Laboratory data were compared between the intravenous immunoglobulin resistant (29 patients) and responsive groups, and between the groups with coronary artery lesions (48 patients) and without coronary artery lesions. RESULTS: The intravenous immunoglobulin resistant group had significantly higher D-dimer, globulin, interleukin-6 and serum ferritin levels in comparison to the intravenous immunoglobulin responder group. D-dimer level had a sensitivity of 87.0% and a specificity of 56.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 1.09 mg/L. Globulin had a sensitivity of 62.1% and a specificity of 82.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 34.7 g/L. Serum ferritin level had a sensitivity of 42.9% and a specificity of 88.8% for predicting intravenous immunoglobulin resistance at a cutoff point of 269.7 ng/mL. The patients with coronary artery lesions had higher D-dimer and tumor necrosis factor-α level. D-dimer level had a sensitivity of 50% and a specificity of 78.6% for predicting coronary artery lesions at a cutoff point of 1.84 mg/L. Based on analysis by multivariate logistic regression, serum ferritin and globulin were independent risks for intravenous immunoglobulin resistance, D-dimer was independent risk for coronary artery lesions. CONCLUSIONS: Elevated serum ferritin, globulin and D-dimer levels are significantly associated with intravenous immunoglobulin resistance in Kawasaki disease. Moreover, serum D-dimer is significantly increased in Kawasaki disease with coronary artery lesions.

Cardiogenic shock: do not forget the possibility of Kawasaki disease.

We report the case of a six-year-old boy who presented with cardiogenic shock due to Kawasaki disease (KD). He was misdiagnosed at first as septic shock. After careful examination, he was diagnosed as KD complicated with acute coronary syndrome, which leads to cardiogenic shock. Cardiogenic shock is often neglected as a complication of KD, and it tends to be misdiagnosed. We hereby call attention to KD, in some cases of which, it can lead to acute coronary syndrome in the acute phase.

[Effects of tree age and basal area on boreal forest tree mortality in Canada].

Taking the poplar (Populus spp.), jack pine (Pinus banksiana), and black spruce (Picea mariana) in northern Canada as test objects, a repeated investigation was conducted on the living and dead trees at 134 fixed sampling plots, and linear regression models were applied to study the effects of tree age, basal area, and stand type on the mortality of the three tree species. Generally, the tree mortality increased with increasing tree age and basal area. Poplar had a higher mortality in jack pine stand but a lower mortality in black spruce stand. In black spruce stand, tree age was the major factor affecting the mortality of jack pine, while in poplar stand, tree basal area was the important factor. In the three stands, tree age had significant effects on the mortality of black spruce. Species composition had significant effects on the mortality of the tree species, and the interactions between tree age, basal area, and stand type all had significant effects on the mortality of each tree species. The mortality of the same tree species in different stands differed significantly.