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Published on: August 28, 2018
Heterogeneity in Kawasaki disease patients with coronary artery abnormalities investigated by data-driven cluster
Yuto Sunaga1, Yohei Hasebe2, Natsumi Kikuchi2
1Department of Pediatrics, University of Yamanashi, Chuo, Yamanashi, Japan. ysunaga@yamanashi.ac.jp.
Insights
This study identified four distinct subgroups of Kawasaki disease (KD) patients with coronary artery abnormalities (CAA) based on clinical features. Understanding these subgroups can improve treatment strategies for KD with CAA.
Area of Science:
- Pediatrics
- Cardiology
- Immunology
Background:
- Kawasaki disease (KD) can lead to coronary artery abnormalities (CAA).
- Clinical characteristics of CAA in acute KD require clarification.
- Heterogeneity in KD cases with CAA may influence outcomes.
Purpose of the Study:
- To clarify clinical characteristics of CAA in acute KD.
- To identify distinct subgroups within KD patients who develop CAA.
- To investigate potential heterogeneity in CAA development in KD.
Main Methods:
- Retrospective cohort study of 103 KD cases with CAA within 30 days of onset.
- Hierarchical cluster analysis performed on 20 continuous variables before treatment.
- Analysis included 726 consecutive KD cases.
Main Results:
- 101 cases clustered into 4 distinct subgroups.
- Subgroups varied by age, inflammatory markers, lipid profiles, liver function, and coronary dilation incidence.
- One subgroup showed younger age, leukocytosis, elevated triglycerides, and good treatment response.
- Another subgroup had older age, elevated liver enzymes, poor treatment response, and low coronary dilation incidence.
Conclusions:
- Four distinct subgroups of KD with CAA were identified.
- These subgroups suggest different underlying mechanisms for CAA development.
- Recognizing heterogeneity is crucial for understanding KD pathophysiology and optimizing treatment.
Background:
To clarify the clinical characteristics associated with coronary artery abnormality (CAA) in the acute phase of Kawasaki disease (KD) cases, we performed a cluster analysis.
Methods:
A retrospective cohort study of 103 KD cases that developed CAA (maximum Z-score for any coronary arteries >2.5) within 30 days after disease onset was conducted among 726 consecutive KD cases. The hierarchical cluster analysis was performed based on 20 continuous variables before treatment.
Results:
101 out of 103 cases were clustered into 4 subgroups. Cluster 1 was a younger group characterized by leukocytosis and elevated serum triglyceride levels with frequent coronary artery dilation before treatment and good initial treatment responses. Cluster 2 was a younger group characterized by anemia and lower serum albumin and total cholesterol levels. Cluster 3 was an older group with frequent coronary artery dilation before treatment. Cluster 4 was an older group characterized by elevated serum aspartate aminotransferase, alanine aminotransferase, and total bilirubin levels, with poor treatment response and the lowest incidence of coronary artery dilatation before treatment.
Conclusion:
We identified four subgroups with distinct features, suggesting different backgrounds for CAA development. Consideration of possible heterogeneity might be helpful for a better understanding of the pathophysiology and better treatment strategies.
Impact:
To investigate possible heterogeneity in Kawasaki disease (KD) cases that developed coronary artery abnormality (CAA) in the acute phase and to evaluate associated clinical characteristics, we performed a cluster analysis in KD cases that developed CAA in the acute phase. Hierarchical cluster analysis in KD cases that developed CAA within 30 days after disease onset, based on clinical data before treatment, identified four subgroups with distinct features, suggesting different backgrounds for CAA development. Cluster analysis might be helpful for a better understanding of the pathophysiology and better treatment strategies in KD cases at high risk for developing CAAs.
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