Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age
DooIl Song1, Yunku Yeo, KeeSoo Ha
1Department of Pediatrics, Korea University College of Medicine, Seoul, South Korea.
Insights
Kawasaki disease (KD) coronary artery abnormalities (CAA) risk differs by age. Incomplete symptoms predict CAA in young children, while non-response to IVGG treatment and higher Harada scores indicate risk in older children.
Area of Science:
- Pediatrics
- Cardiology
- Immunology
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Coronary artery abnormalities (CAA) are the most serious complication of KD.
- Age-specific risk factors and clinical manifestations for KD-associated CAA are not well understood.
Purpose of the Study:
- To investigate the age-specific clinical manifestations and risk factors for developing CAA in KD patients.
- To compare CAA development in infants and older children diagnosed with KD.
Main Methods:
- Retrospective review of medical records of 161 infants (<1 year) and 60 older children (>5 years) diagnosed with KD.
- Comparison of clinical and laboratory findings between patients with and without CAA.
- Multivariable logistic regression analysis to identify significant predictors of CAA.
Main Results:
- Overall CAA incidence was 6.7%, with 12.4% in the younger group and 16.7% in the older group.
- In younger children, fewer diagnostic symptoms were associated with CAA development.
- In older children, prolonged fever post-IVGG treatment and higher Harada scores were significant predictors of CAA.
Conclusions:
- Incomplete KD symptoms in infants and IVGG non-responsiveness in older children are associated with KD-CAA.
- Age-specific characteristics are crucial for tailoring diagnostic and therapeutic strategies for KD.
- Early identification of at-risk patients can improve outcomes and prevent severe cardiac complications.
Introduction:
The clinical manifestations and risk factors for developing coronary artery abnormalities (CAA) in Kawasaki disease (KD) might differ depending on age.
Materials And Methods:
From January 2001 to July 2007, 161 patients with an age younger than 1 year (younger group) and 60 patients with an age older than 5 years (older group) were diagnosed with KD at the Korea University Medical Center. Their medical records were reviewed retrospectively and the two groups were compared in terms of a number of variables commonly associated with the development of CAA, including clinical manifestations and laboratory findings.
Results:
While the overall incidence of KD-associated CAA in our hospital was 6.7%, CAA developed in 20 (12.4%) of the younger group and ten (16.7%) of the older group, respectively. The CAA (+) cases of the younger group had a longer duration of total fever (9.1 +/- 3.3 vs 6.3 +/- 1.9 days, p = 0.002) and showed fewer diagnostic symptoms (3.0 +/- 1.2 vs 4.3 +/- 1.1, p < 0.001) than the CAA (-) cases. The CAA (+) cases of the older group had a longer duration of total fever (14.1 +/- 10.4 vs 6.5 +/- 1.9 days, p = 0.045), especially with respect to post-intravenous gamma globulin (IVGG) fever (7.9 +/- 9.6 vs 1.1 +/- 0.8 days, p = 0.052), and had higher total white blood cell counts, erythrocyte sedimentation rates, C-reactive protein levels, total bilirubin levels, and Harada scores and lower serum albumin and sodium levels than the CAA (-) cases. Multivariable logistic regression analysis revealed that the factors that were associated significantly with the development of CAA were the number of total symptoms (OR = 0.494, 95% confidence interval (CI) = 0.281-0.871, p = 0.015) in the younger group and the duration of post-IVGG fever (OR = 1.958, 95% CI = 1.098-3.492, p = 0.023) and the Harada score (OR = 3.455, 95% CI = 1.012-11.796, p = 0.048) in the older group.
Conclusion:
Incomplete clinical manifestations in the younger group and IVGG nonresponsiveness in the older group are associated with the development of KD-associated CAA. These age-specific characteristics could aid the customization of the diagnostic and therapeutic strategies of KD, thereby helping to improve the outcome of this disease.
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