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[Clinical characteristics and risk factors of recurrent Kawasaki disease]
1Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Infection and Immunity, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
Insights
Recurrent Kawasaki disease risk factors include Mycoplasma pneumoniae infection, intravenous immunoglobulin resistance, and elevated C-reactive protein and platelet levels. Children with Kawasaki disease require at least two years of follow-up post-initial episode.
Area of Science:
- Pediatrics
- Rheumatology
- Infectious Diseases
Background:
- Kawasaki disease (KD) is an acute febrile vasculitis primarily affecting young children.
- Recurrence of KD poses significant challenges in management and increases the risk of coronary artery abnormalities.
Purpose of the Study:
- To identify clinical characteristics and risk factors associated with recurrent Kawasaki disease.
- To develop a predictive model for recurrent KD.
Main Methods:
- Retrospective analysis of 41 recurrent KD cases and 123 non-recurrent KD controls.
- Comparison of clinical data using Chi-square and Mann-Whitney U tests.
- Logistic regression and ROC analysis to determine independent risk factors.
Main Results:
- Recurrence often occurs within two years of the initial episode.
- Compared to the first episode, recurrent episodes showed lower white blood cell counts and extremity edema rates, shorter fever duration before treatment, and higher hemoglobin and albumin levels.
- Independent risk factors for recurrence included C-reactive protein >97.5 mg/L, platelet count >276 × 10^9/L, intravenous immunoglobulin resistance, and Mycoplasma pneumoniae infection.
Conclusions:
- Children with Kawasaki disease need at least two years of follow-up.
- Elevated C-reactive protein, platelet count, history of Mycoplasma pneumoniae infection, and resistance to initial intravenous immunoglobulin treatment are significant predictors of KD recurrence.
Abstract:
Objective: To summarize the clinical characteristics and explore the risk factors of recurrent Kawasaki disease. Methods: In this retrospective study, reviewed 41 cases with recurrent Kawasaki disease in Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University from January 2013 to January 2021. And another 123 children with Kawasaki disease who had no recurrence during at least 6 years of follow-up were assigned into control group. Furthermore, the risk factors of recurrence were derived by comparing the clinical characteristics of recurrent cases at their initial episodes with those of control cases by Chi-square test and the Mann-Whitney U test, followed by Logistic regression and receiver operating characteristic analysis. Results: There were 29 males and 12 females in 41 children with recurrent Kawasaki disease, 33 children (80%) suffered a recurrence within 2 years after the first episode and 8 children (20%) developed a recurrence after 2 years. Compared with the first episode, the second episode had lower white blood cell count (15.2 (12.8-18.8)×109 vs. 18.0 (14.9-23.4)×109/L, Z=-2.462, P=0.014) and rate of edema in extremities (54% (22/41) vs. 76% (31/41), χ2=4.321, P=0.038), shorter fever durations before intravenous immunoglobulin treatment (5.0 (5.0-6.0) vs. 6.0 (5.0-7.5) d, Z=-3.329, P=0.001) and higher levels of hemoglobin ((116±8) vs. (107±12)g/L, t=-4.124, P<0.05) and albumin((39±5) vs. (36±6) g/L, t=-3.009, P=0.004). Multivariate Logistic regression analysis showed that C-reaction protein>97.5 mg/L (OR=3.014, 95%CI 1.350-6.730, P=0.007), platelet >276 × 109/L (OR=4.099, 95%CI 1.309-12.838, P=0.015), intravenous immunoglobulin resistance (OR=9.239, 95%CI 1.178-72.477, P=0.034), Mycoplasma pneumoniae infection (OR=2.585, 95%CI 1.129-5.922, P=0.025) were independent risk factors for recurrent Kawasaki disease recurrence.The predictive model then was generated using these four risk factors. The receiver operating characteristic analysis showed that the area under curve was 0.732 (95%CI 0.647-0.817). When the cut-off was 0.241, the sensitivity and specificity were 63.4% and 70.7%, respectively. Conclusions: Children with Kawasaki disease should be followed up for at least 2 years after the first episode and should pay more attention to C-reactive protein. Children with Mycoplasma pneumoniae infection, intravenous immunoglobulin resistance, higher C-reactive protein and platelet at the first onset have a higher risk of recurrent Kawasaki disease.
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