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Published on: January 28, 2020
Risk factors associated with persistent coronary artery lesions in children with Kawasaki disease in an Italian
Fiorentina Guida1, Elisabetta Morana2, Elena Maria Tarì3
1Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy.
Insights
Identifying persistent coronary artery lesions (pCALs) in Kawasaki disease (KD) is crucial. Male sex, young age, Asian ethnicity, incomplete presentation, and elevated CRP are key risk factors for pCALs in Italian children.
Area of Science:
- Pediatrics
- Cardiology
- Immunology
Background:
- Kawasaki disease (KD) can lead to coronary artery lesions (CALs), increasing long-term cardiovascular risks if they persist beyond the acute phase (pCALs).
- Existing risk scores for CALs or treatment resistance are primarily based on Asian and American populations, with limited focus on pCALs risk factors.
- Identifying predictors for pCALs is essential for timely intervention and improved patient outcomes.
Purpose of the Study:
- To identify independent risk factors for pCALs in a cohort of Italian children diagnosed with KD.
- To evaluate the predictive performance of the Son's risk score for pCALs in a predominantly Caucasian population.
Main Methods:
- A multicenter study collected data from 517 children with KD across 11 Italian centers.
- pCALs were defined as lesions persisting 8 weeks post-diagnosis.
- Logistic regression identified independent risk factors, and ROC analysis assessed Son's risk score's predictive ability.
Main Results:
- pCALs were observed in 52 children, more frequently in males, infants under 6 months, those with Asian ethnicity, incomplete KD presentation, and abnormal abdominal ultrasound findings.
- Elevated white blood cell count, C-reactive protein (CRP), and lower hemoglobin levels were associated with pCALs.
- Son's risk score demonstrated good predictive ability for pCALs in this cohort.
Conclusions:
- Male sex, younger age, incomplete KD presentation, Asian ethnicity, and elevated CRP are significant independent risk factors for pCALs in Italian children.
- Son's risk score is a valuable tool for identifying high-risk patients who may benefit from closer monitoring and early adjunctive therapy, even in Caucasian populations.
Abstract:
Kawasaki disease (KD) can be complicated-particularly during the acute phase-by coronary artery lesions (CALs). The persistence of CALs (pCALs) beyond the subacute phase increases the risk of long-term cardiovascular morbidity and life-threatening events. While several risk scores, primarily based on Asian and American populations, have been proposed to predict CALs or treatment resistance, few studies have focused on identifying risk factors for pCALs. This study aimed to identify risk factors for pCALs in Italian patients and to evaluate the validity of an existing risk score developed in a North American cohort. Data from KD patients across 11 Italian centers were collected in a centralized RedCap database. pCALs were defined as CALs persisting 8 weeks post-diagnosis. Clinical, demographic, and laboratory features of patients with and without pCALs were compared. Independent risk factors were identified using multiple logistic regression. The predictive performance of Son's risk score was assessed through ROC analysis. A total of 517 children (87.4% Caucasian) were enrolled; 52 developed pCALs. pCALs were more common in males (12.03%, p = 0.06), patients < 6 months (61.5%, p = 0.05), those with Asian ethnicity (26.9%, p = 0.026), incomplete clinical presentation (p = 0.03), and in those with abnormal abdominal ultrasound findings (p = 0.04). Affected children had higher WBC, elevated CRP (> 13 mg/dL), and lower hemoglobin. Compared to those with acute CALs, patients with pCALs were younger, more often IVIG non-responders (34.6% vs. 29.6%, p < 0.001), and late-treated. Son's score showed good predictive ability for pCALs.Conclusions: Male sex, younger age, incomplete presentation, Asian ethnicity, and elevated CRP are independent risk factors for pCALs in Italian children with KD. Son's score may help identify high-risk patients who could benefit from closer follow-up and early adjunctive therapy, even in predominantly Caucasian populations. What is Known: • Kawasaki disease can cause CALs, which increase cardiovascular risk if they persist • Previous research has focused mainly on predicting CALs or treatment resistance, but little evidence is available on the risk factors for CALs persistence What is New: • Our study identifies independent risk factors for pCALs in Italian children: male gender, younger age, incomplete presentation, Asian ethnicity, and high CRP levels • By applying the Son Risk Score to our population, we confirmed its predictive value in a predominantly Caucasian cohort and its reliability in identifying susceptibility to CALs persistence.
