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Relationship between serum sodium level and coronary artery abnormality in Kawasaki disease
Sora Park1, Lucy Youngmin Eun1, Ji Hong Kim2
1Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
Insights
Hyponatremia, or low serum sodium levels, may indicate a worse prognosis for coronary artery issues in children with Kawasaki disease (KD). Further research is needed to confirm the link between sodium levels and coronary arteriopathy in KD patients.
Area of Science:
- Pediatric Rheumatology
- Cardiovascular Research
- Clinical Chemistry
Background:
- Kawasaki disease (KD) is a critical pediatric vasculitis often leading to coronary artery abnormalities.
- Serum sodium levels are implicated in vascular injury and may influence KD progression.
- Understanding predictors of cardiac events in KD is crucial for early intervention.
Purpose of the Study:
- To investigate the association between initial serum sodium levels and the occurrence of cardiac and coronary artery events in pediatric patients diagnosed with KD.
- To identify potential serum sodium thresholds that may predict adverse cardiovascular outcomes in KD.
Main Methods:
- A retrospective analysis of 104 pediatric patients diagnosed with KD between January 2015 and December 2015.
- Patients were categorized into hyponatremia (<135 mEq/L) and normonatremia groups based on initial serum sodium levels.
- Analysis included laboratory findings and echocardiographic data, focusing on coronary artery Z-scores.
Main Results:
- Out of 91 eligible patients, 48 (52.7%) presented with hyponatremia.
- Hyponatremic patients exhibited higher levels of inflammatory markers (WBC, neutrophils, ESR, CRP), fever, total bilirubin, and brain natriuretic peptide.
- A trend towards larger coronary artery diameters (higher Z-scores) was observed in the hyponatremia group.
Conclusions:
- Hyponatremia in acute KD may correlate with increased vascular inflammation and potentially a poorer prognosis for coronary vasculature.
- While this study did not find a statistically significant link between initial serum sodium and coronary arteriopathy, it highlights a concerning trend.
- Long-term studies with larger cohorts are recommended to definitively establish the relationship between serum sodium levels and coronary arteriopathy in Kawasaki disease.
Purpose:
Kawasaki disease (KD) is an immune-related multisystemic vasculitis that occurs in children, especially ensuing from a coronary artery abnormality. Sodium level is known to be related to vascular injury, which could affect the progress of KD. The purpose of this study was to determine the serum sodium levels that could predict the occurrence of cardiac and coronary artery events in KD.
Methods:
We conducted a retrospective review of medical records for 104 patients with KD from January 2015 to December 2015. Patients with serum Na levels of <135 mEq/L at the time of initial diagnosis were assigned to the hyponatremia group. Laboratory findings and echocardiographic data were analyzed for various aspects.
Results:
Among the 104 patients with KD, 91 were included in the study, of whom 48 (52.7%) had hyponatremia. The degree of fever, white blood cell count, percentage of neutrophils, percentage of lymphocytes, total bilirubin level, brain natriuretic peptide level, erythrocyte sedimentation rate, and C-reactive protein level were higher in the patients with hyponatremia. They also demonstrated a trend of larger coronary artery diameters based on Z scores.
Conclusion:
The severity of vascular inflammation in acute KD with hyponatremia might worsen the prognosis of coronary vasculature. Although no statistically significant correlation was found between the initial serum sodium levels and coronary arteriopathy in the patients with KD in this study, a long-term follow-up study with a larger number of enrolled patients should be designed in the future to elucidate the relationship between serum sodium level and coronary arteriopathy in patients with KD.
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