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Cardiac pathology and outcomes vary between Kawasaki disease and PIMS-TS

Susanna Felsenstein1, Phuoc Duong2, Steven Lane3

  • 1Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, UK.

Clinical Immunology (Orlando, Fla.)
|June 12, 2021
PubMed

Insights

Kawasaki disease (KD) and Pediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS) share cardiac concerns. PIMS-TS patients were older with more severe cardiac issues, yet PIMS-TS showed more favorable outcomes than KD.

Area of Science:

  • Pediatric Rheumatology
  • Infectious Diseases
  • Cardiology

Background:

  • Kawasaki disease (KD) and Pediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS) present with overlapping clinical features.
  • This overlap necessitates an investigation into shared pathophysiological mechanisms and disease outcomes between KD and PIMS-TS.

Purpose of the Study:

  • To compare the clinical characteristics, cardiac involvement, and outcomes of children diagnosed with KD and PIMS-TS.
  • To identify predictors of outcomes in both KD and PIMS-TS patients.

Main Methods:

  • Retrospective analysis of medical records from English patients diagnosed with KD (2015-2020) and PIMS-TS (2020-2021).
  • Data extracted included demographics, clinical features, laboratory findings, cardiac involvement, treatment, and outcomes.
  • Statistical comparison between the KD and PIMS-TS cohorts.

Main Results:

  • PIMS-TS patients were older and more frequently of minority ethnicity compared to KD patients.
  • Cytopenias and hyperferritinemia were more common in PIMS-TS, associated with diffuse cardiac involvement.
  • While cardiac pathology in PIMS-TS could be severe and late-onset, outcomes were more favorable than in KD. Baseline coronary diameter predicted outcomes in both groups.

Conclusions:

  • PIMS-TS cardiac involvement may stem from a cytokine storm, presenting more severely but with a better prognosis than KD.
  • The favorable prognosis of PIMS-TS cardiac involvement may reduce the need for long-term follow-up post-recovery.
  • Understanding these differences is crucial for appropriate management and prognosis in pediatric inflammatory conditions.

Keywords:
COVIDKDKawasakiMIS-COutcomePIMS-TSPediatricTreatment

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