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Cardiac lesions and initial laboratory data in Kawasaki disease: a nationwide survey in Japan
Masanari Kuwabara1, Mayumi Yashiro, Kazuhiko Kotani
1Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi; Department of Cardiology, Toranomon Hospital, Tokyo, Japan.
Insights
Early identification of cardiac lesions in Kawasaki disease is crucial. Male sex, older age, elevated platelet count, low albumin, and high C-reactive protein (CRP) are key risk factors in the initial disease phase.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Infectious Diseases
Background:
- Kawasaki disease can lead to cardiac lesions like coronary dilatation and aneurysms.
- Most research focuses on later stages, neglecting early indicators.
- This study investigates early-phase cardiac lesion risk factors.
Purpose of the Study:
- To identify factors associated with cardiac lesions in the initial phase of Kawasaki disease.
- To correlate laboratory data with cardiac manifestations in early Kawasaki disease.
- To inform early risk assessment and management strategies.
Main Methods:
- Cross-sectional study of 23,155 patients from Japan's 22nd nationwide Kawasaki disease survey (2011-2012).
- Analysis included patients within 7 days of symptom onset, excluding recurrent cases.
- Laboratory data analyzed: white blood cell count, platelet count, serum albumin, and C-reactive protein (CRP).
Main Results:
- Cardiac lesions occurred in 984 patients (3.4%), primarily coronary dilatation (764).
- Factors for coronary dilatation: male sex (OR 1.73), older age (OR 1.03), higher platelets (OR 1.006), lower albumin (OR 0.66), higher CRP (OR 1.02).
- Coronary aneurysms linked to higher platelets (OR 1.01) and lower albumin (OR 0.34). Valvular lesions associated with age (OR 0.98) and higher CRP (OR 1.05).
Conclusions:
- Male sex, older age, elevated platelet count, low serum albumin, and high CRP are significant predictors of cardiac lesions in early Kawasaki disease.
- These factors aid clinicians in assessing cardiac risk during the initial disease phase.
- Early identification of these factors can guide timely intervention and management.
Background:
Cardiac lesions, such as coronary dilatation, aneurysms, narrowing, myocardial infarction, and valvular lesions, sometimes occur in Kawasaki disease, but most studies have only evaluated cardiac lesions in the later phase of the disease. This study was undertaken to clarify the related factors between cardiac lesions and laboratory data in the initial phase of Kawasaki disease.
Methods:
We conducted a cross-sectional study using data for 26 691 patients from the 22nd nationwide survey of Kawasaki disease in Japan, the observation period of which was from January 2011 through December 2012. We excluded patients with recurrent Kawasaki disease and who were more than seven days from the start of symptoms at admission. We analyzed 23 155 cases (13 353 boys; mean age: 923 ± 734 days) with available laboratory data for white blood cell count, platelet count, serum albumin, and C-reactive protein (CRP).
Results:
Cardiac lesions were detected in 984 cases (656 boys and 328 girls); lesions were classified as coronary dilatation (764 cases), coronary aneurysm (40), giant coronary aneurysm (6), coronary narrowing (3), and valvular lesions (204). The significant related factors of initial coronary dilatation were male sex (odds ratio [OR] 1.73), older age (OR per 100 days increase 1.03), higher platelet count (OR per 10 000 cells/µL increase 1.006), lower albumin (OR per 1 g/dL increase 0.66), and higher CRP (OR per 1 mg/dL increase 1.02). The factors related to coronary aneurysm were higher platelet count (OR 1.01) and lower albumin (OR 0.34). No factors were significantly related to giant coronary aneurysm. The related factors of valvular lesions were age (OR 0.98), and higher CRP (OR 1.05).
Conclusions:
Clinicians should consider male sex, older age, higher platelet count, lower albumin levels, and higher CRP levels when assessing risk of cardiac lesions in the initial phase of Kawasaki disease.
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