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Published on: January 28, 2020
[Predictive indicators and risk model construction for coronary artery lesions in Kawasaki disease children over 5
1Department of Cardiology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology/Wuhan Maternal and Child Healthcare Hospital, Wuhan 430016.
Insights
Predictive indicators for coronary artery lesions (CAL) in Kawasaki disease (KD) children over 5 years old include prolonged fever duration before IVIG treatment, elevated hs-CRP, and high serum ferritin. These factors aid in constructing a KD CAL risk prediction model.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Immunology
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Coronary artery lesions (CAL) are the most serious complication of KD, potentially leading to long-term cardiovascular issues.
- Early identification of children at high risk for CAL is crucial for timely intervention.
Purpose of the Study:
- To identify predictive indicators for the development of coronary artery lesions (CAL) in children diagnosed with Kawasaki disease (KD) who are over 5 years old.
- To develop and validate a risk prediction model for CAL in this specific pediatric population.
- To quantify the contribution of identified risk factors using a scoring system.
Main Methods:
- Retrospective analysis of KD patients over 5 years old diagnosed between January 2018 and January 2023.
- Multivariate logistic regression was employed to identify significant predictive indicators for CAL.
- Receiver operating characteristic (ROC) curve analysis and Framingham risk scoring were used to evaluate model effectiveness and quantify risk.
Main Results:
- Predictive indicators for CAL in KD children over 5 years old included: longer duration of fever before initial intravenous immunoglobulin (IVIG) treatment (OR=1.374), elevated hypersensitive C-reactive protein (hs-CRP) levels (OR=1.008), and increased serum ferritin levels (OR=1.002).
- Optimal cutoff values were determined: fever duration (6.5 days), hs-CRP (110.50 mg/L), and ferritin (313.62 mg/L), with corresponding AUC values indicating predictive ability.
- A risk scoring model was established, categorizing patients into low, medium, and high-risk groups based on calculated scores.
Conclusions:
- In children over 5 years old with Kawasaki disease, a prolonged fever duration before initial IVIG treatment, higher hs-CRP levels, and elevated serum ferritin are significant predictors of coronary artery lesion development.
- The developed risk prediction model and scoring system can aid clinicians in stratifying CAL risk in KD patients.
- Early recognition of these indicators can facilitate timely management and potentially mitigate cardiovascular complications.
Objectives:
To study predictive indicators for coronary artery lesions (CAL) and construct a risk prediction model for CAL in Kawasaki disease (KD) children over 5 years old.
Methods:
A retrospective analysis of KD children over 5 years old at Wuhan Children's Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2018 to January 2023 was conducted. Among them, 47 cases were complicated with CAL, and 178 cases were not. Multivariate logistic regression analysis was used to explore predictive indicators for CAL in KD children over 5 years old and construct a risk prediction model. The receiver operating characteristic curve was used to evaluate the effectiveness of the prediction model. Finally, the Framingham risk scoring method was used to quantify the predictive indicators, calculate the contribution of each indicator to the prediction of CAL in KD children over 5 years old, and construct a risk prediction scoring model.
Results:
The multivariate logistic regression analysis showed that the duration of fever before the initial intravenous immunoglobulin (IVIG) treatment (OR=1.374, 95%CI: 1.117-1.689), levels of hypersensitive C-reactive protein (hs-CRP; OR=1.008, 95%CI: 1.001-1.015), and serum ferritin levels (OR=1.002, 95%CI: 1.001-1.003) were predictive indicators for CAL in KD children over 5 years old. The optimal cutoff values for predicting CAL were: duration of fever before initial IVIG treatment of 6.5 days (AUC=0.654, 95%CI: 0.565-0.744), hs-CRP of 110.50 mg/L (AUC=0.686, 95%CI: 0.597-0.774), and ferritin of 313.62 mg/L (AUC=0.724, 95%CI: 0.642-0.805). According to the Framingham risk scoring method, the low, medium, and high-risk states of CAL occurrence were defined as probabilities of <10%, 10%-20%, and >20%, respectively, with corresponding scores of 0-4 points, 5-6 points, and ≥7 points.
Conclusions:
In KD children over 5 years old, those with a longer duration of fever before initial IVIG treatment, higher levels of hs-CRP, or elevated serum ferritin levels are more likely to develop CAL.
