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Evaluation of Risk Factors of Coronary Artery Abnormalities in Incomplete Kawasaki Disease: An Analysis of Post RAISE
Serena Hamanaka1, Shogo Akahoshi2, Takahiro Matsushima1
1Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Insights
High platelet count and pre-existing coronary artery abnormalities (CAA) are key risk factors for developing CAA in incomplete Kawasaki disease (iKD) patients. Early identification aids in managing this condition.
Area of Science:
- Pediatrics
- Cardiology
- Rheumatology
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Incomplete Kawasaki disease (iKD) presents diagnostic challenges, with limited evidence on managing associated risks.
- Coronary artery abnormalities (CAA) are a significant complication of KD, necessitating early risk factor identification.
Purpose of the Study:
- To investigate independent risk factors for coronary artery abnormalities (CAA) in patients with incomplete Kawasaki disease (iKD).
- To provide evidence to support the American Heart Association's algorithm for iKD management.
- To identify predictive markers for CAA development in iKD.
Main Methods:
- Secondary analysis of the prospective cohort study, Post RAISE, involving Japanese KD patients.
- Inclusion criteria: iKD patients treated within 10 days of onset.
- Statistical analysis: Multiple logistic regression to identify independent risk factors for CAA (Z score ≥ 2.5) one month post-treatment.
Main Results:
- Of 565 iKD patients, 5.7% developed CAA.
- Univariate analysis showed young age, high platelet count, and pre-treatment CAA were associated with CAA development.
- Multivariate analysis identified elevated platelet count (>45 × 10^4/μL) and pre-treatment CAA as significant independent risk factors for CAA.
Conclusions:
- Elevated platelet count and the presence of CAA before treatment are significant risk factors for developing CAA in iKD patients.
- These findings can refine risk stratification and management strategies for iKD.
- Further research may focus on incorporating these factors into clinical decision-making tools.
Aim:
The American Heart Association provides an algorithm for managing suspected incomplete Kawasaki disease (iKD), but the evidence remains limited. This study aimed to investigate the risk factors of coronary artery abnormalities (CAA) in iKD patients.
Methods:
This study was a secondary analysis of Post RAISE, a prospective cohort study of Japanese KD patients. The primary analysis included patients treated within 10 days of onset. CAA was defined by a Z score of the coronary artery diameter ≥ 2.5. Multiple logistic regression analysis was used to identify independent risk factors of CAA 1 month after treatment commencement.
Results:
Post RAISE enrolled 2628 KD patients, of whom 565 with iKD were included in the main analysis. Of the latter, 32 (5.7%; 95% confidence interval [CI]: 3.9-7.7) developed CAA 1 month after treatment commencement. The baseline factors significantly associated with CAA development on univariate analysis were young age (median: 10.8 vs. 20.8 months; p = 0.002), high platelet count (39.6 × 104 vs. 33.5 × 104/μL; p = 0.008), and pre-treatment presence of CAA (38 vs. 11%; p < 0.001). Multivariate analysis of the independent variables, including age ≤ 12 months, platelet count > 45 × 104/μL, prednisolone use, and the pre-treatment presence of CAA, revealed a significant association of platelet count > 45 × 104/μL (odds ratio: 3.46; 95% CI: 1.43-8.13) and the pre-treatment presence of CAA (4.62; 1.93-10.85) with the primary outcome.
Conclusions:
A high platelet count and pre-treatment presence of CAA were risk factors of CAA development in iKD patients 1 month after treatment commencement.
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