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A new scoring system to predict Kawasaki disease with coronary artery lesions
Wang Hua1, Feiyue Ma1, Ying Wang1
1Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, No. 3333, Binsheng Road, Hangzhou, 310052, People's Republic of China.
Insights
Kawasaki disease (KD) with coronary artery lesions (CAL) is linked to male sex, prolonged fever, IVIG resistance, low albumin, and elevated eosinophils and monocytes. Specific factors predict CAL in infants under 6 months.
Area of Science:
- Pediatrics
- Cardiology
- Rheumatology
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Coronary artery lesions (CAL) are the most serious complication of KD.
- Identifying risk factors for CAL is crucial for timely intervention.
Purpose of the Study:
- To identify independent risk factors for CAL in acute and subacute KD.
- To develop a scoring system for predicting CAL in KD patients.
- To analyze risk factors specifically in infants (≤6 months old).
Main Methods:
- Retrospective review of 2305 KD inpatients (2009-2014).
- Analysis of clinical and laboratory data during acute and subacute stages.
- Logistic regression and ROC curve analysis to identify risk factors and predictive values.
Main Results:
- The overall CAL rate was 24.1%.
- Independent risk factors for CAL included male sex, fever duration ≥8 days, IVIG resistance, albumin ≤35.9 g/L, eosinophils ≥2.2%, and monocytes ≥5.9%.
- In infants ≤6 months, fever duration ≥8 days, delayed diagnosis, and albumin ≤35.9 g/L were significant predictors (AUC=0.731).
Conclusions:
- Male sex, prolonged fever, IVIG resistance, low albumin, and elevated eosinophils/monocytes are independent risk factors for CAL in KD.
- A combination of prolonged fever, delayed diagnosis, and low albumin effectively predicts CAL in infants ≤6 months old.
Objectives:
To clarify the independent risk factors and construct a scoring system for Kawasaki disease (KD) with coronary artery lesions (CAL) at acute and subacute stages.
Method:
Data of KD inpatients at acute and subacute stages were reviewed in a tertiary care center from January 2009 to December 2014.
Results:
A total of 2305 acute and subacute KD cases were enrolled in this study with a CAL rate of 24.1%. The OR (95%CI) values of male, total fever duration ≥ 8 days, IVIG resistance (IVIGR), albumin (ALB) ≤ 35.9 g/L, eosionphils (EO) ≥ 2.2%, and monocytes (MO) ≥ 5.9% were 1.45 (1.15-1.82), 1.78 (1.43-2.22), 1.42 (1.09-1.85), 1.53 (1.23-1.91), 1.17 (0.94-1.45), and 1.37 (1.09-1.69), respectively. In patients ≤ 6 months old, the OR (95%CI) values for total fever duration ≥8 days, delayed diagnosis, and ALB ≤ 35.9 g/L were 3.61 (2.02-6.45), 3.49 (1.49-8.16), and 2.07 (1.14-3.74), respectively. ROC curve showed that the AUC value and sensitivity and specificity of predicting KD with CAL in patients ≤ 6 months old were 0.731, 64.7%, and 80.9%, respectively.
Conclusions:
The independent risk factors for acute and subacute KD combined with CAL, including being a boy, long fever duration, IVIGR, low ALB, elevated EO, and MO. Joint of parameters (total fever duration ≥ 8 days, delayed diagnosis, and ALB ≤ 35.9 g/L) can be used to predict the occurrence of CAL in KD patients ≤ 6 months old.
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