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Japanese Kawasaki Disease Scoring Systems: Are they Applicable to the Iranian Population?
Mohammad Reza Edraki1, Hamid Mohammadi1, Nima Mehdizadegan1
1Neonatology and Cardiac Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Kawasaki disease scores show limited accuracy in predicting coronary artery aneurysms in Iranian children. Age under one year is a risk factor for treatment resistance.
Area of Science:
- Pediatrics
- Cardiology
- Rheumatology
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Coronary artery aneurysms (CAA) are a significant complication of KD.
- Predictive scoring systems for CAA and treatment resistance are crucial for timely intervention.
Purpose of the Study:
- To evaluate the diagnostic accuracy of five established Kawasaki disease scores for predicting CAA and intravenous immunoglobulin (IVIG) resistance.
- To assess the applicability of these scores in an Iranian pediatric population.
Main Methods:
- A retrospective cross-sectional study of 121 pediatric KD patients.
- Data collected included clinical, laboratory, and echocardiographic findings.
- Five KD scores (Kobayashi, Egami, Sano, Nakano, Harada) were analyzed against CAA and IVIG resistance outcomes.
Main Results:
- The incidence of CAA and IVIG resistance was 16.5% and 13.2%, respectively.
- All five scores demonstrated low sensitivity for predicting CAA or IVIG resistance.
- The Harada score had the highest sensitivity (50%) but remained below screening test criteria; other scores showed high specificity (>85%).
- Younger age (under one year) was significantly associated with IVIG resistance.
Conclusions:
- Established KD scoring systems have limited clinical utility for identifying high-risk Iranian children.
- Age under one year is a significant risk factor for IVIG resistance in Kawasaki disease.
- Further research is needed to develop culturally adapted or novel predictive tools for KD complications.
Background:
Kawasaki disease (KD) is the most frequent cause of coronary artery aneurysm (CAA) in children. This study tried to evaluate the accuracy of different KD scores developed for prediction of CAA, in an Iranian population.
Methods:
This is a cross-sectional retrospective investigation on pediatric patients with a diagnosis of KD. Clinical manifestations, laboratory, and echocardiographic data were recorded. Five Kawasaki scores, including Kobayashi, Egami, Sano, Nakano, and Harada, were assessed and analyzed in relation to CAA and intravenous immunoglobulin (IVIG) resistance.
Results:
During five years, we recruited 121 cases of KD under 13 years of age. The rates of CAA and IVIG resistance were 16.5%, and 13.2% respectively. The IVIG resistance group was significantly younger than responder patients. All five scores had low sensitivity in predicting CAA or IVIG resistant cases; the highest sensitivity pertained to the Harada score with 50% sensitivity and 59% specificity (the area under the curve: 0.545, with a 95% confidence interval: 0.423 to 0.667) in predicting CAA, which is lower than the usual acceptable criteria for a screening test. The specificity of all other scores were more than 85% in predicting CAA or IVIG resistance. Gender, fever before therapy and laboratory data showed no significant difference between the groups.
Conclusion:
The Kobayashi, Egami, Sano, Nakano and Harada scores have limited usefulness in the Iranian population to predict high risk patients for coronary artery involvement or IVIG resistance; in our study, age under one year was a risk factor for IVIG resistance.
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