A prediction model for coronary artery abnormalities in children with Kawasaki disease older than 5 years

Yang, Penghui; Zhang, Jing; Chen, Zhuo; Yi, Qijian

doi:10.1016/j.jped.2023.12.002

Cited by 1 publication

(1 citation statement)

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“…Notably, children over 5 years of age have been reported to have a substantially higher risk of exhibiting CVAs due to delay in diagnosis, as the treating physicians may more frequently consider febrile exanthemata or viral infections instead of KD during differential diagnosis of an older child with persistently unmanageable fever [ 31 ]. A nomogram model using the neutrophil-to-lymphocyte ratio is in progress to assess and predict any potential risk of CVAs in older children and adolescents with KD [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Hypovitaminosis D and Leukocytosis to Predict Cardiovascular Abnormalities in Children with Kawasaki Disease: Insights from a Single-Center Retrospective Observational Cohort Study

Rigante,

De Rosa,

Delogu

et al. 2024

Diagnostics

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Introduction: An aberrant immune response involving yet unidentified environmental and genetic factors plays a crucial role in triggering Kawasaki disease (KD). Aims: The aim of this study was to assess general and laboratory data at the onset of KD in a single-center cohort of children managed between 2003 and 2023 and retrospectively evaluate any potential relationship with the development of KD-related cardiovascular abnormalities (CVAs). Patients and methods: We took into account a total of 65 consecutive children with KD (42 males, median age: 22 months, age range: 2–88 months) followed at the Department of Life Sciences and Public Health in our University; demographic data, clinical signs, and laboratory variables at disease onset, before IVIG infusion, including C-reactive protein, hemoglobin, white blood cell (WBC) count, neutrophil count, platelet count, aminotransferases, natremia, albumin, total bilirubin, and 25-hydroxyvitamin D were evaluated. Results: Twenty-one children (32.3% of the whole cohort) were found to have echocardiographic evidence of CVAs. Univariate analysis showed that diagnosis of KD at <1 year or >5 years was associated with CVAs (p = 0.001 and p = 0.01, respectively); patients with CVAs had a longer fever duration and mostly presented atypical or incomplete presentations. Interestingly, all patients with CVAs had lower levels of vitamin D (less than 30 mg/dL, p = 0.0001) and both higher WBC and higher neutrophil counts than those without CVAs (p = 0.0001 and p = 0.01, respectively). Moreover, blood levels of albumin were significantly lower in KD patients with CVAs compared to those without (11/21, 52% versus 13/44, 30%, p = 0.02). Multiple logistic regression with correction for sex showed that serum vitamin D < 30 ng/mL, WBC count > 20.000/mm3, and age > 60 months at KD onset were the only independent factors statistically associated with CVAs. Conclusions: Hypovitaminosis D, WBC count over 20.000/mm3, and age above 5 years at KD onset emerged as independent factors statistically associated with the occurrence of CVAs.

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Section: Discussionmentioning

confidence: 99%