Epidemiologic Features and Prognostic Factors of Coronary Artery Lesions Associated With Kawasaki Disease Based on a 13-Year Cohort of Consecutive Cases Identified by Complete Enumeration Surveys in Wakayama, Japan

Abstract

BackgroundTo clarify the contribution of patient age to the development of coronary artery lesions (CALs) associated with Kawasaki disease (KD), epidemiologic features and prognostic factors were investigated using hospital-based complete enumeration surveys in a specific area.MethodsConsecutive KD cases identified between October 1999 and September 2012 in Wakayama Prefecture, Japan, were analyzed. The primary outcome measure was the presence/absence of CALs (giant aneurysm, mid- or small-sized aneurysm, and dilatation) on echocardiography 1 month after disease onset. Demographics and medical treatment factors were compared between the patients with and without CALs. Odds ratios (ORs) and 95% confidence intervals (CIs) of explanatory variables (age, gender, and factors related to high-dose intravenous immunoglobulin treatment) for the development of CALs were determined.ResultsThe median age of the 1415 patients (796 males, 619 females) was 25 months after excluding 2 children of foreign residents; 2.2% of the patients had a past history of KD, and 1.8% showed incomplete presentation. CALs were observed in 3.3% (4.0% of males, 2.3% of females; P = 0.080). The ORs of CALs among patients <11 months old (3.0, 95% CI 1.4–6.6) and those >48 months old (3.1, 95% CI 1.5–6.6) were significantly higher than values in 11- to 48-month-olds.ConclusionsThe effect of patient age on the development of CALs was found to be U-shaped, with the bottom at ages 11 to 48 months. This finding was based on a 13-year cohort of consecutive KD cases in a specific area with little selection bias and is consistent with previously reported results.

Risk of coronary artery involvement in Kawasaki disease

“…Other previously described risk factors for the development of CAD, like age under 1 year old or older than 9 years old, leukocytosis or hyponatremia were not confirmed in our study, probably because of the sample size limitation. N. Kitano et al, 13 in a cohort of consecutive cases consisting of 1415 patients with KD, found that a rate of patients with CAD was significantly lower in the 11 to 48 month old age group (2%, 17/859), compared to the group of children younger than 11 months old and older than 48 months old (5.2%, 29/556), respectively (p= 0.001). These findings agree with our data because 3 out of the 5 patients with CAD were younger than 11 months old and one was older than 48 months old.…”

Riesgo de afectación coronaria en la enfermedad de Kawasaki

“…Otros factores de riesgo previamente descritos para el desarrollo de AC, como la edad menor de un año o mayor de 9 años, la leucocitosis o la hiponatremia, no se confirmaron en nuestro estudio, probablemente debido a la limitación que supone el tamaño muestral. N. Kitano et al, 13 en una cohorte de casos consecutivos formada por 1415 pacientes con EK, encontraron que la proporción de pacientes con AC era significativamente menor en el grupo de edad de 11 a 48 meses (2%, 17/859), comparada con el grupo formado por los menores de 11 y los mayores de 48 meses (5,2%, 29/556), respectivamente (p= 0,001). Estos resultados son concordantes con nuestros datos, ya que, de los 5 pacientes con AC, tres eran menores de 11 meses y uno era mayor de 48 meses.…”

Kawasaki Disease: The Clinical and Cardiologic Early-Term Characteristics and Prognoses of 44 Children with Acute Attack

“…6 KH sistemik bir vaskülit olduğu için temel olarak koroner arterler etkilenmekte ve tedavi edilmeyen olguların %20-25'inde KAH gelişmektedir. 6,7 En sık komplikasyonlardan biri olan koroner arter anevrizmasında, intimal kalınlaşma ve kalsifikasyon sonucunda koroner arter oklüzyonu ve iskemik kalp hastalığı gelişebilmektedir. 7,18 Çalışmamızda da literatürle uyumlu olarak hastaların %25'inde koroner arter tutulumu gözlenmiştir.…”

“…6,7 En sık komplikasyonlardan biri olan koroner arter anevrizmasında, intimal kalınlaşma ve kalsifikasyon sonucunda koroner arter oklüzyonu ve iskemik kalp hastalığı gelişebilmektedir. 7,18 Çalışmamızda da literatürle uyumlu olarak hastaların %25'inde koroner arter tutulumu gözlenmiştir. Akut dönemde verdiğimiz tedaviyle anevrizması olan hastaların yarısında tam iyileşme gözlenirken; kalanında minimal arter dilatasyonu olarak devam etmiştir.…”

“…TARTIŞMA KH, tanımlandığından bu yana hem çocukluk ça-ğında görülen sistemik vaskülitler arasında, hem de edinsel kalp hastalıkları nedenleri içerisinde önemli bir yer tutmaktadır. 6,7 Başta Japonya olmak üzere Asya'da sık görülmekle birlikte (beş yaş altı çocuklarda 264:100 000), son yıllarda Batı ülkele-rinde de sıklığı artmaktadır. 6 Dr. Kawasaki tarafın-dan bildirilen ilk 50 olgudan bu yana, Japonya kaynaklı yayınlarda KH hastalarının sayısı yaklaşık 300.000'i bulmuştur.…”