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Age-Specific Cardiovascular and Platelet Dynamics in Kawasaki Disease
Fen Wang1, Zhongxing Lu2, Haitao Lv3
1Department of Pediatrics, The First People's Hospital of Taicang City, Taicang, Jiangsu, 215400, People's Republic of China.
Insights
Kawasaki disease (KD) shows age-specific symptoms and platelet responses. Timely intervention and platelet monitoring are crucial for managing cardiovascular risks in children with KD.
Area of Science:
- Pediatrics
- Cardiology
- Immunology
Background:
- Kawasaki disease (KD) is a critical pediatric illness affecting blood vessels.
- Understanding age-specific variations in KD is essential for effective management.
Purpose of the Study:
- To investigate age-related differences in Kawasaki disease clinical features, treatment outcomes, and platelet behavior.
- To identify predictors of severe cardiovascular complications in KD patients.
Main Methods:
- Retrospective analysis of 221 Kawasaki disease patients categorized into infant, toddler, and child groups.
- Comparison of clinical symptoms, echocardiography findings, treatment responses, and platelet counts.
- Multivariate logistic regression to determine independent predictors of cardiovascular damage.
Main Results:
- Toddlers and older children exhibited more pronounced symptoms like lymphadenopathy and peeling.
- Cardiovascular damage occurred in 56.1% of patients; intravenous immunoglobulin (IVIG) resistance was 31.7%.
- Delayed treatment (≥10 days) and elevated platelet distribution width were linked to severe cardiovascular issues.
Conclusions:
- Kawasaki disease presents with age-specific clinical and platelet dynamics.
- Treatment delays and IVIG resistance negatively impact cardiovascular outcomes.
- Age-tailored diagnostic and treatment strategies, emphasizing early intervention and platelet monitoring, are recommended.
Objective:
To characterise age-specific differences in clinical manifestations, treatment response and platelet dynamics in Kawasaki disease (KD).
Methods:
A retrospective analysis was conducted on 221 patients with KD who were admitted to the cardiology department of Suzhou Children's Hospital between June 2015 and May 2016. Patients were divided into three groups based on age: the infant group (≤12 months), the toddler group (>12 months to ≤36 months) and the child group (>36 months to ≤10 years). Clinical symptoms, signs, echocardiography (ECHO) findings, treatment characteristics and platelet counts were compared among the groups. Multivariate logistic regression was performed to identify independent predictors of severe cardiovascular damage. A P-value of <0.05 was considered significant.
Results:
Major symptoms, such as lymph node enlargement and finger (toe) peeling, were significantly more pronounced in the toddler and child groups (P < 0.05). The overall incidence of cardiovascular damage was 56.1%, with 31.7% experiencing intravenous immunoglobulin (IVIG) resistance. Treatment delay (≥10 days from fever onset) occurred in 18.6% of cases and was associated with increased cardiovascular severity (adjusted odds ratio [aOR] = 2.45, 95% confidence interval [CI] 1.32-4.56, P = 0.004). Platelet counts and plateletcrit increased significantly during the acute and subacute phases, with the infant group exhibiting significantly higher platelet responses than the toddler and child groups (all P < 0.05). Multivariate analysis revealed that elevated platelet distribution width was independently associated with moderate-to-severe coronary artery lesions (aOR = 1.38, 95% CI 1.09-1.74, P = 0.007).
Conclusion:
The clinical characteristics, ECHO findings, treatment patterns and platelet changes in patients with KD exhibit partial age-related differences. Treatment delay and IVIG resistance significantly impact cardiovascular outcomes. Clinicians are advised to incorporate age-specific diagnostic and treatment strategies, paying particular attention to timely intervention and platelet monitoring to facilitate early recognition and optimise clinical outcomes.
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