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MIS-C Overlap, Not Prior COVID-19 Itself, Drives Treatment Escalation in Kawasaki Disease: A Nationwide Cohort Study

Min Ji Kim1, Jong Seung Kim2, Jee Young Hong3

  • 1Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Korea.

Pediatrics International : Official Journal of the Japan Pediatric Society
|July 13, 2026
PubMed

Insights

Prior coronavirus disease 2019 (COVID-19) does not independently affect Kawasaki disease (KD) treatment response in children. Multisystem inflammatory syndrome in children (MIS-C) concurrent with KD, not prior COVID-19, drives increased need for escalated treatment.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Immunology

Background:

  • The independent impact of prior coronavirus disease 2019 (COVID-19) on Kawasaki disease (KD) treatment outcomes remains unclear.
  • Previous studies may be confounded by the overlap between COVID-19 and multisystem inflammatory syndrome in children (MIS-C).

Purpose of the Study:

  • To investigate whether prior COVID-19 independently influences treatment response in children diagnosed with KD.
  • To differentiate the effects of prior COVID-19 from MIS-C on KD treatment escalation.

Main Methods:

  • Retrospective cohort study using the Korean National Health Insurance Service database.
  • Included children diagnosed with KD on or after January 1, 2020, receiving IVIG within 7 days.
  • Utilized 1:1 propensity score matching, accounting for age, sex, MIS-C status, and steroid use.

Main Results:

  • Prior COVID-19 was not independently associated with the need for second-line treatment in KD patients (adjusted HR 1.42; 95% CI 0.83-2.43).
  • An elevated risk for second-line treatment was observed in children with concurrent MIS-C (HR 3.01; 95% CI 1.34-6.74).
  • Children with prior COVID-19 but without MIS-C showed no increased risk for escalated treatment (HR 1.18; 95% CI 0.66-2.11).

Conclusions:

  • Prior COVID-19 alone is not an independent predictor of second-line treatment in Kawasaki disease when MIS-C and steroid use are considered.
  • Multisystem inflammatory syndrome in children (MIS-C) is the primary driver of increased treatment escalation in KD patients with a history of COVID-19.
  • Distinguishing MIS-C from classic KD is crucial for appropriate treatment and management.
Abstract

Keywords:
COVID‐19Kawasaki diseaseSARS‐CoV‐2intravenous immunoglobulinsmultisystem inflammatory syndrome in children

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