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Risk factors for coronary arterial involvement in Turkish children with Kawasaki disease: a multicenter retrospective
Serkan Türkuçar1, Ümmüşen Akça Kaya2, Figen Çakmak3
1Department of Pediatric Rheumatology, Dokuz Eylül University Faculty of Medicine, İzmir.
Insights
Younger age, male gender, and prolonged fever before IVIG are key risk factors for coronary arterial lesions in Turkish children with Kawasaki disease (KD). These findings aid in predicting and preventing CALs in KD patients.
Area of Science:
- Pediatric Rheumatology
- Cardiology
- Immunology
Background:
- Coronary arterial lesions (CALs) are a significant complication of Kawasaki disease (KD), impacting patient morbidity despite treatment.
- Identifying risk factors for CALs is crucial for effective management in pediatric populations.
Purpose of the Study:
- To determine the independent risk factors for developing CALs in Turkish children diagnosed with KD.
- To develop a practical risk-scoring system for predicting CALs in KD.
Main Methods:
- Retrospective review of medical records from 399 KD patients across five Turkish pediatric rheumatology centers.
- Analysis of demographic, clinical (fever duration, IVIG resistance), laboratory, and echocardiographic data.
- Logistic regression analysis to identify independent risk factors for CALs.
Main Results:
- Younger age (≤12 months), male gender, and prolonged fever duration (≥9.5 days) before IVIG were identified as independent risk factors for CALs.
- High sensitivity (up to 94.5%) was achieved in predicting CALs based on these parameters, though specificity was lower (16.5%).
- Patients with CALs were younger, predominantly male, and had longer fever duration before IVIG treatment.
Conclusions:
- An easily applicable risk-scoring system was developed to predict CALs in Turkish children with KD.
- This system can aid in tailoring treatment and follow-up strategies to prevent coronary artery involvement.
- Further research is needed to validate these risk factors in other Caucasian populations.
Background:
Coronary arterial lesions (CALs) are the major component of Kawasaki disease (KD), associated with significant morbidity, which affect a substantial proportion of patients despite proper treatment. The aim of this study was to define the risk factors for CALs in Turkish children with KD.
Methods:
Medical records of 399 KD patients from five pediatric rheumatology centers in Turkey were reviewed retrospectively. Demographic, clinical (including duration of fever before intravenous immunoglobulin [IVIG] and resistance to IVIG), laboratory and echocardiographic data were noted.
Results:
The patients with CALs were younger, had a higher male ratio and a longer duration of fever before IVIG. They also had higher lymphocyte and lower hemoglobin values before the initial treatment. Multiple logistic regression analyses defined the following three criteria as independent risk factors for predicting CALs in Turkish children with KD: age ≤12 months, male gender and duration of fever before IVIG ≥9.5 days. High sensitivity rates of elevated risk of CALs up to 94.5% were calculated despite specificity values falling to 16.5%, depending on which of these three parameters are taken into account.
Conclusions:
Based on the demographic and clinical features, we established an easily applicable risk-scoring system for predicting CALs in Turkish children with KD. This may be useful for choosing appropriate treatment and follow-up for KD to prevent coronary artery involvement. Further studies will show whether these risk factors can be used in other Caucasian populations as well.
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