1529. Kawasaki Disease Shock Syndrome: Identifying Risks

BACKGROUND: Kawasaki disease shock syndrome (KDSS) is a severe and less common complication of Kawasaki disease (KD). KDSS may progress rapidly and mimic other types of shock. Limited data are available in the literature describing recognition, evaluation, and treatment of KDSS. This report compares children with KDSS with those with KD without shock syndrome in 149 consecutive patients over 4.5 years in Central Texas. METHODS: Inpatient medical records of children with ICD diagnosis code for KD who were hospitalized between January 2014 and July 2018 at one children’s hospital in Texas were identified and charts were manually reviewed for inclusion. Cases were categorized as having KDSS if they had a diagnosis of KD with sustained systolic hypotension for age or signs or symptoms of shock with poor perfusion including tachycardia with delayed capillary refill, change in mental status, or weak peripheral pulses. Information about each case was collected from the chart including demographics, presentation, medical treatments, laboratory data, and initial echocardiograms. RESULTS: KD was identified in 149 patients; 22 were categorized as KDSS (14.8%). Among cases of KDSS, sustained systolic hypotension for age was observed in 19 patients; 3 patients had other signs of hemodynamic instability. Select details for each cohort are in Figure 1. Patients with KDSS were overall older on admission (6.2 vs. 2.3 years; P <0.001), and more likely to have anemia, neutrophilia, bandemia, thrombocytopenia, hypoalbuminemia, or hyponatremia. On acute echocardiogram, 5 of the 22 patients had coronary artery changes including ectasia, and dilation, and highest Z-score between 2.2–4.24. Patients with KDSS were more likely to receive steroids or adjunctive medications and had a longer length of stay (6 vs. 3.7 days; P < 0.001). CONCLUSION: The current literature has relatively few cases of KDSS and suggests risk of misdiagnosis of KDSS initially as other types of shock. We demonstrate a higher incidence of KDSS; 14.8% compared with between 1.5 and 7% at KD diagnosis reported in the literature. The cause of this is unclear but may indicate regional or genetic differences in disease course. Patients with KD should be monitored for KDSS to avoid unexpected decompensation or delay in treatment. Lab abnormalities may indicate risk for KDSS. [Image: see text] DISCLOSURES: All authors: No reported disclosures.