Development of a score for early identification of children with Kawasaki disease requiring second-line treatment in multi-ethnic populations in Europe: A multicentre retrospective cohort study

Ouldali, Naïm; Dellepiane, Rosa Maria; Torreggiani, Sofia; Mauri, Lucia; Beaujour, Gladys; Beyler, Constance; Cucchetti, Martina; Dumaine, Cécile; Vecchia, Adriano La; Melki, Isabelle; Stracquadaino, Rita; Vinit, Caroline; Cimaz, Rolando; Meinzer, Ulrich

doi:10.1016/j.lanepe.2022.100481

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…We tested both a baseline Z-score ≥ 2 and ≥ 2.5, with a Z-score ≥ 2 showing higher associations with the outcomes. We also evaluated the Kawanet and the Kawanetecho score performances, which were developed in the European cohort [12,13], but none of them was associated with CAAs. Consisting with previous studies, we found that Japanese scores have low performance for the non-Japanese population [9,10,12,18,19].…”

Section: Discussionmentioning

confidence: 99%

“…The Kawanet score was developed in France in 2020 to predict IVIG resistance in non-Asian populations [12]. In 2022, a multicentre study in Italy and France developed the Kawanet-echo score, a combination of the Kawanet score with the baseline echocardiography findings, that showed a better performance for IVIG resistance prediction than the Kawanet score and a maximal Z-score ≥ 2 [13]. Table 1 shows the scoring systems evaluated in the present study.…”

Section: Introductionmentioning

confidence: 96%

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Risk factors and scores for prediction of coronary artery aneurysms in Kawasaki disease: a European monocentric study

La Vecchia,

Stracquadaino,

Mauri

et al. 2024

BMC Pediatr

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Background Japanese Kawasaki disease (KD) risk scores cannot be adopted in non-Japanese patients. In North American populations a baseline coronary artery Z-score > 2 and the Son score are associated with coronary artery aneurysms (CAAs) at 4 and 8 weeks from disease onset. In European populations, the Kawanet and Kawanet-echo scores are associated with intravenous immunoglobulin resistance. This study aims to evaluate the association between KD risk scores and baseline coronary artery Z-scores with CAAs at one, two, and six months in a European population. Methods Historical cohort study of all the children diagnosed with KD in a tertiary care hospital in Milan, Italy, between 1st January 2015 and 31st May 2021. Univariate and multivariate (adjusting for age and corticosteroid therapy) logistic regression analyses were used to study the association between the risk scores, a baseline Z-score ≥ 2 and ≥ 2.5 with CAAs. Results Eighty-nine patients were diagnosed with KD at our Centre, and 12 were excluded based on the exclusion criteria. We included 77 patients, 51 (66%) males, and 26 (34%) females, with a median age at presentation of 27 months (IQR 13–46). A baseline Z-score ≥ 2 was correlated with CAAs at one and two-month follow-ups (odds ratio (OR) 10, 95% confidence interval (CI) 2–72, and OR 18, CI 3-357) but not at six-month follow-up. The Son score showed an association with one and two-month follow-up CAAs (OR 3, CI 1.3-7, and OR 3, CI 1.3-8) but not with a six-month follow-up. Conclusions Patients with a baseline Z-score ≥ 2 are at higher risk for CAAs in the long term. The Son score should be tested in larger European samples. Further studies should keep the observational periods longer than 8 weeks from KD onset.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Risk factors and scores for prediction of coronary artery aneurysms in Kawasaki disease: a European monocentric study

La Vecchia,

Stracquadaino,

Mauri

et al. 2024

BMC Pediatr

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“… 9 Ouldali et al, made a first attempt at reproducing the Kawanet score in an independent multi-ethnic cohort including Asian children. 3 The performance of the Kawanet score was lower in their cohort compared to the training cohort. As presence of coronary dilatations and myocardial dysfunction were associated with the risk of non-response to IVIG, it made sense to combine them in a scoring system.…”

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confidence: 93%

“…In a retrospective study including 363 consecutive children with KD admitted to two tertiary hospitals in France and Italy, Ouldali et al, have demonstrated that the presence of fever 2 days post IVIG treatment was significantly associated with CAA at week 6; a point which should be considered for a more homogeneous definition of IVIG-resistance within international recommendations. 3 Altogether, stratifying treatment according to each patient's individual risk may improve long-term prognosis. Targeting risk factors is challenging when there is a lack of agreement for a definitive diagnosis and when the evolution of the disease is swift requiring treatment in an emergency setting.…”

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confidence: 99%

Importance of predicting non-response to intravenous immunoglobulin therapy in non-Asian patients with Kawasaki disease

Koné‐Paut

Piram²

2022

The Lancet Regional Health - Europe

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Kawasaki disease, multisystem inflammatory syndrome in children, and adenoviral infection: a scoring system to guide differential diagnosis

Fabi,

Dondi,

Andreozzi

et al. 2023

Eur J Pediatr

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Children with Kawasaki disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C), and Adenovirus infections (AI) of the upper respiratory tract show overlapping features. This study aims to develop a scoring system based on clinical or laboratory parameters to differentiate KD or MIS-C from AI patients. Ninety pediatric patients diagnosed with KD (n = 30), MIS-C (n = 26), and AI (n = 34) admitted to the Pediatric Emergency Unit of S.Orsola University Hospital in Bologna, Italy, from April 2018 to December 2021 were enrolled. Demographic, clinical, and laboratory data were recorded. A multivariable logistic regression analysis was performed, and a scoring system was subsequently developed. A simple model (clinical score), including five clinical parameters, and a complex model (clinic-lab score), resulting from the addition of one laboratory parameter, were developed and yielded 100% sensitivity and 80% specificity with a score ≥2 and 98.3% sensitivity and 83.3% specificity with a score ≥3, respectively, for MIS-C and KD diagnosis, as compared to AI. Conclusion: This scoring system, intended for both outpatients and inpatients, might limit overtesting, contribute to a more effective use of resources, and help the clinician not underestimate the true risk of KD or MIS-C among patients with an incidental Adenovirus detection. What is Known:• Kawasaki Disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C) and adenoviral infections share overlapping clinical presentation in persistently febrile children, making differential diagnosis challenging.• Scoring systems have been developed to identify high-risk KD patients and discriminate KD from MIS-C patients. What is New:• This is the first scoring model based on clinical criteria to distinguish adenoviral infection from KD and MIS-C.• The score might be used by general pediatricians before referring febrile children to the emergency department.

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Development of a score for early identification of children with Kawasaki disease requiring second-line treatment in multi-ethnic populations in Europe: A multicentre retrospective cohort study

Cited by 5 publications

References 24 publications

Risk factors and scores for prediction of coronary artery aneurysms in Kawasaki disease: a European monocentric study

Risk factors and scores for prediction of coronary artery aneurysms in Kawasaki disease: a European monocentric study

Importance of predicting non-response to intravenous immunoglobulin therapy in non-Asian patients with Kawasaki disease

Kawasaki disease, multisystem inflammatory syndrome in children, and adenoviral infection: a scoring system to guide differential diagnosis

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