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Serum sodium level associated with coronary artery lesions in patients with Kawasaki disease
Hiroya Masuda1,2, Ryusuke Ae3, Taka-Aki Koshimizu4
1Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan.
Insights
Serum sodium levels impact coronary artery lesion (CAL) risk differently in infants and older children with Kawasaki disease (KD). Infants developing CALs often have normal sodium levels, unlike older children who typically have lower levels.
Area of Science:
- Pediatrics
- Cardiology
- Endocrinology
Background:
- Kawasaki disease (KD) can lead to coronary artery lesions (CALs).
- Hyponatremia is a potential risk factor for CALs in KD patients.
- Serum sodium reference intervals differ between infants and older children.
Purpose of the Study:
- To investigate the association between serum sodium levels and CAL complications in KD patients.
- To determine if this association differs between infants and older children.
Main Methods:
- Analysis of 21,610 KD patients in Japan (2013-2014).
- Multivariable logistic regression to assess serum sodium and CAL association.
- Stratification of analysis by age group (infants vs. older patients).
Main Results:
- CALs identified in 3.6% of infants and 1.8% of older patients.
- Infants with CALs were more likely to have normal sodium levels (75%) compared to older patients (29%).
- Serum sodium ≤130 mEq/L significantly increased CAL risk in both groups (aOR 3.21 in infants, 1.74 in older patients).
Conclusions:
- Serum sodium distribution associated with CALs differs significantly between infants and older KD patients.
- Hyponatremia is not always a risk factor for CALs in infants, unlike in older children.
- Age-specific risk assessments for CALs in KD are crucial when using serum sodium levels.
Introduction/Objectives:
Hyponatremia is a potential risk factor for the development of coronary artery lesions (CALs) identified after acute Kawasaki disease (KD). However, the serum sodium distribution corresponding to the reference intervals differs between infants (< 1 year of age) and older children. We hypothesized the association of serum sodium level with CAL complications differs between infants and older patients with KD.
Methods:
We analyzed 21,610 population-based patients who developed KD throughout Japan during 2013-2014. We performed multivariable logistic regression analyses to evaluate the association between serum sodium and CAL complications. Additionally, we stratified the serum sodium distribution associated with CAL complications by infants and older patients.
Results:
CALs were identified in 158 (3.6%) infants and 302 (1.8%) older patients. Infants were more likely to develop CALs when within the normal sodium range compared with older patients (75% vs. 29%), whereas most older patients developed CALs with a sodium level lower than the reference interval. Serum sodium ≤ 130 mEq/L indicated significantly higher risk for development of CALs in both groups (adjusted odds ratio [95% confidence intervals] = 3.21 [1.65-6.25] in infants and 1.74 [1.18-2.57] in older patients).
Conclusions:
Serum sodium distribution associated with CAL complications differed greatly between infants and older patients. Older patients developed CALs with sodium levels lower than the reference interval; however, among infants, hyponatremia was not necessarily a risk factor for developing coronary artery lesion. When considering risk assessments for CALs using serum sodium levels, infants with KD should be distinguished from older patients. Key Points • Hyponatremia is a potential risk factor for the development of coronary artery lesions (CALs) among patients with Kawasaki disease. • However, the serum sodium distribution corresponding to the reference intervals differs between infants (< 1 year of age) and older children. • Most infants developed CALs within the normal sodium range, whereas older patients developed at a range lower than the reference interval. • These findings highlight that when considering risk assessments for CALs using serum sodium levels, infants should be distinguished from older patients.
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