Overweight, obesity and coronary artery lesions among Kawasaki disease patients

Shi, Honglian; Weng, Fengfeng; Li, Chen; Jin, Zengyou; Hu, Junyong; Chu, Maoping; Qiu, Huixian

doi:10.1016/j.numecd.2021.01.015

Cited by 10 publications

(15 citation statements)

References 33 publications

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“…However, the adiposity z score remained higher in the present study for patients with MIS-C after adjusting for age, sex, and race and ethnicity. With respect to KD, the prevalence of overweight and obesity (both 11.5%) was similar to a previous study of Chinese children with KD (18.5%) …”

Section: Discussionsupporting

confidence: 87%

“…Associations between obesity and MIS-C outcomes, however, have been found inconsistently across studies to date . Moreover, studies evaluating the outcomes of children with obesity and KD remain largely lacking, apart from a single study . Given that excessive adipose tissue in individuals with obesity is associated with a systemic inflammatory state, it is possible that obesity mediates disease severity in both KD and MIS-C.…”

Section: Introductionmentioning

confidence: 99%

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Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children

Khoury,

Harahsheh,

Raghuveer

et al. 2023

JAMA Netw Open

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ImportanceObesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.ObjectiveTo compare the prevalence of obesity and associations with clinical outcomes in patients with KD or MIS-C.Design, Setting, and ParticipantsIn this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded.Main Outcomes and MeasuresPatient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI &lt;85th percentile), overweight (BMI ≥85th to &lt;95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups.ResultsOf 1767 children, 338 with KD (median age, 2.5 [IQR, 1.2-5.0] years; 60.4% male) and 1429 with MIS-C (median age, 8.7 [IQR, 5.3-12.4] years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P &lt; .001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD.Conclusions and RelevanceIn this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children

Khoury,

Harahsheh,

Raghuveer

et al. 2023

JAMA Netw Open

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“…It is known that obesity and cardiovascular diseases are positively associated [ 8 , 9 ]. While KD has also been reported to affect the coronary artery, a recent study pointed out that obesity may be an independent risk factor for coronary artery lesions among KD patients [ 10 , 11 , 12 ]. Therefore, it is important to discuss body mass index (BMI), which is negatively associated with a patient’s exercise capacity, as an indicator of CPF in patients with KD [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Differences between Sexes in Cardiopulmonary Fitness among Children and Adolescents with Kawasaki Disease

et al. 2022

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It is known that children and adolescents with Kawasaki disease (KD) can maintain normal cardiopulmonary fitness (CPF) after the disease’s acute stage has subsided. This study aimed to investigate whether gender differences affect CPF in children and adolescents with KD. We retrospectively reviewed a cohort of 204 participants (120 boys and 84 girls) with KD. All participants were instructed to complete a symptom-limited cardiopulmonary exercise test (CPET) adapted to assess their CPF. Based on body mass index (BMI), boys and girls were categorized into groups of underweight (19 boys and 12 girls), normal (62 boys and 59 girls), and overweight (39 boys and 13 girls). Although a similarity in body composition was found among both genders for KD subjects and normal Taiwanese peers, the percentage of overweight subjects was higher in KD boys than the normal Taiwanese boys. When comparing CPF for different BMI groups, the whole KD group showed no discrepancy, but a significantly lower peak VO2 for the overweight KD boys group was observed, representing poorer CPF. In conclusion, girls with KD had better CPF than boys, and gender stereotypes affect sports participation as well as self-efficacy, and may be contributing to poorer CPF in KD boys.

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“…Second, large sample-sized studies are in need to validate the role of TN-C in KD patients of different populations. Besides, indicators like N-terminal pro-brain natriuretic peptide, calcitonin, weight for height, D-dimer, eosionphils, interleukin-6, interleukin-10, and ferritin were not included in the present study ( 29 , 45 , 46 ). Given the absence of some clinical parameters, the effectiveness of part of reported systems to predict CALs in Chinese population has not been validated in our study.…”

Section: Discussionmentioning

confidence: 99%

Tenascin-C predicts IVIG non-responsiveness and coronary artery lesions in kawasaki disease in a Chinese cohort

et al. 2022

Front. Pediatr.

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ObjectivesTo assess the predictive value of tenascin-C (TN-C) for intravenous immunoglobulin (IVIG) non-responsiveness and coronary artery lesions (CALs) development at the acute stage of Kawasaki disease, and to build novel scoring systems for identifying IVIG non-responsiveness and CALs.MethodsA total of 261 patients in acute-stage Kawasaki disease were included. Serum samples before IVIG initiation were collected and TN-C expression levels were measured using an enzyme-linked immunosorbent assay. In addition to TN-C, another fifteen clinical and laboratory parameters collected before treatment were compared between IVIG responsive and non-responsive groups, and between groups with and without CALs. Multiple logistic regression analyses were performed to construct new scoring systems for the prediction of IVIG non-responsiveness and CALs development.ResultsIVIG non-responsive group (n = 51) had significantly higher TN-C level compared to IVIG responsive group (n = 210) (15.44 vs. 12.38 IU/L, P < 0.001). A novel scoring system composed of TN-C, total bilirubin, serum sodium and albumin was established to predict IVIG non-responsiveness. Patients with a total score ≥ 2 points were classified as high-risk cases. With the sensitivity of 78.4% and specificity of 73.8%, the efficiency of our scoring system for predicting IVIG non-responsiveness was comparable to the Kobayashi system. Consistently, the group developing CALs at the acute stage (n = 42) had significantly higher TN-C level compared to the group without CALs (n = 219) (19.76 vs. 12.10 IU/L, P < 0.001). A new scoring system showed that patients with elevated TN-C, platelet count ≥ 450 × 109/L, and delayed initial infusion of IVIG had a higher risk of developing CALs. Individuals with a total score ≥ 3 points were classified as high-risk cases. The sensitivity and specificity of the novel simple system for predicting CALs development were 83.3% and 74.0%, respectively, yielding a better efficiency than the Harada score.ConclusionElevated TN-C appeared to be an independent risk factor for both IVIG non-responsiveness and CALs in Chinese children with KD. Our scoring systems containing TN-C is simple and efficient in the early identification of high-risk KD cases that could benefit from more individualized medications.

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Overweight, obesity and coronary artery lesions among Kawasaki disease patients

Cited by 10 publications

References 33 publications

Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children

Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children

Differences between Sexes in Cardiopulmonary Fitness among Children and Adolescents with Kawasaki Disease

Tenascin-C predicts IVIG non-responsiveness and coronary artery lesions in kawasaki disease in a Chinese cohort

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