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[Review and analysis of 283 cases of Kawasaki disease]
1Department of Internal Medicine, Capital Institute for Pediatrics, Beijing 100020, China.
Insights
Kawasaki Disease (KD) can cause cardiac complications, with coronary artery abnormalities occurring in 36.9% before treatment. Male patients and prolonged fever are risk factors for coronary artery aneurysms in KD.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Rheumatology
Context:
- Kawasaki Disease (KD) is a critical pediatric illness.
- Cardiac complications are a major concern in KD management.
- Understanding risk factors for coronary artery aneurysms (CAA) is vital.
Purpose:
- To review Kawasaki Disease cases and analyze clinical features.
- To investigate cardiac complications, particularly coronary artery abnormalities.
- To identify risk factors associated with coronary artery aneurysms.
Summary:
- A review of 283 KD patients (1992-2002) revealed fever, oral mucosal changes, cervical lymphadenopathy, conjunctivitis, extremity changes, and rash as common symptoms.
- Coronary artery abnormalities were present in 36.9% before treatment and 13.3% after IVIG. The prevalence of CAA was 4.7%.
- Male sex and fever duration exceeding 9 days were identified as significant risk factors for CAA.
Impact:
- Highlights the early occurrence of cardiac complications in KD.
- Provides insights into the effectiveness of IVIG in mitigating new coronary artery abnormalities.
- Informs clinical practice regarding risk stratification and management of KD patients.
Objective:
The aim of the study was to review the cases of Kawasaki Disease (KD) and analyze the clinical features especially their cardiac complications.
Methods:
Totally 283 patients with KD were hospitalized from 1992 to 2002. Their clinical features and factors associated with increased risk of coronary artery aneurysms were reviewed.
Results:
(1) Among the 283 KD patients, 186 were male and 97 were female. The male-female ratio was 1.9:1. Most of them (71%) were younger than 3 years old. Seasonal peak was in spring and summer (from May to Aug). Depending on the criteria of KD, 228 (81%) were diagnosed as typical KD and 55 (19.4%) were atypical KD. All patients had fever, lasting for 6.1 days. The most common clinical features were oral mucosal changes (97.5%) and cervical lymphadenopathy (95.4%), conjunctivitis (91.2%). And changes in the extremities (89.8%) and rash (81.5%) were also noted. (2) Before the treatment, coronary artery abnormalities were seen in 103/279 (36.9%), which occurred within 4 - 30 days of fever onset. Two weeks after intravenous gamma globulin (IVIG) treatment, the new cases of coronary artery abnormalities were 28/211 (13.3%). The prevalence of coronary artery aneurysms (CAA) with KD was 4.7%. The risk factors of CAA were male cases (P < 0.05) and fever lasting longer than 9 days (P < 0.05). Other cardiac abnormalities in acute phase included left atrial and ventricular enlargement (40/279, 14.3%) and changes in ECG (57/274, 20.8%). The pericardial effusions were found in 11 cases (3.9%).
Conclusions:
Cardiac complications of KD occurred in the early period of KD. The new cases of coronary artery abnormalities were 13.3% after IVIG treatment. The risk factors of CAA included male cases and fever lasting for longer time.
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