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Treatment and Coronary Artery Aneurysm Formation in Kawasaki Disease: A Per-Day Risk Analysis

Diana van Stijn1, Justin M Korbee1, Stejara A Netea1

  • 1Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

The Journal of Pediatrics
|December 30, 2021
PubMed

Insights

Delayed treatment for Kawasaki disease increases the risk of medium and giant coronary artery aneurysms (CAAs). Every day of delay elevates the risk, with no safe treatment day identified.

Area of Science:

  • Pediatrics
  • Cardiology
  • Infectious Diseases

Background:

  • Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
  • Coronary artery aneurysms (CAAs) are a significant complication of KD.
  • Intravenous immunoglobulin (IVIG) is the standard treatment to reduce CAA formation.

Purpose of the Study:

  • To evaluate the impact of treatment day on Kawasaki disease outcomes.
  • To determine if delayed treatment increases the risk of coronary artery aneurysm development.
  • To analyze the per-day risk associated with delayed KD treatment.

Main Methods:

  • Retrospective analysis of 776 patients with Kawasaki disease.
  • Multivariate analysis using treatment day as a continuous variable.
  • Categorization of patients based on CAA size: none, small, medium, and giant.

Main Results:

  • Late treatment initiation was a significant predictor of larger CAA development.
  • The odds ratio for medium CAAs increased by 1.1 per delayed day of treatment (P < .05).
  • The odds ratio for giant CAAs increased by 1.2 per delayed day of treatment (P < .05).

Conclusions:

  • Each day of delay in treating Kawasaki disease increases the risk of medium and giant CAA formation.
  • No specific treatment day was identified as a 'safe zone' for preventing CAAs.
  • Prompt treatment initiation is crucial for mitigating CAA risk in Kawasaki disease patients.
Abstract

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