Prediction of Coronary Artery Aneurysms in Children With Kawasaki Disease Before Starting Initial Treatment

Abstract

Background: Precisely predicting coronary artery aneurysms (CAAs) remains a clinical challenge. We aimed to investigate whether coronary dimensions adjusted for body surface area (Z scores) on baseline echocardiography and clinical variables before primary treatment could predict the presence of late CAAs.Methods: We conducted a retrospective study including children hospitalized for Kawasaki disease and received intravenous immunoglobulin within 10 days of illness. We defined late CAAs as a maximum Z score (Zmax) ≥2.5 of the left main, right, or left anterior descending coronary artery at 11–60 days of illness. Associations between late CAAs and clinical parameters and baseline maximum Z scores were analyzed.Results: Among the 314 included children, 31 (9.9%) had late CAAs. Male, higher C-reactive protein, and higher baseline Zmax were risk factors of late CAAs. Late CAAs were significantly associated with baseline Zmax ≥2.0 vs. <2.0 (25 [32.5%] vs. 6 [2.5%], P < 0.001). The odds ratio for late CAAs among the patients with baseline Zmax ≥2.0 vs. <2.0 was 18.5 (95% confidence interval, 7.23 to 47.41, P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of baseline Zmax ≥2.0 for the presence of later CAAs were 80.6, 81.6, 32.5, and 97.5%, respectively.Conclusions: Findings from this study suggest that Zmax ≥2.0 of coronary arteries on baseline echocardiography may be used to predict children at a high risk of late CAAs and allow for targeted early intensification therapy.

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

“…Previous studies indicated that abnormal coronary and extra-coronary findings on initial echocardiography may be associated with resistance to IVIG 15 , 19 and subsequent CAA development. 20 , 24 , 22 Our study confirms, in two European KD cohorts, the association between a coronary artery maximal Z-score ≥ 2.0 at the initial echocardiography and severe KD, as measured by the need for second-line treatments and persistence of fever 48h after the end of initial IVIG treatment. Baseline z scores had moderate sensitivity and the highest specificity of all the models in this cohort.…”

“…However, it has also been proposed to be useful in the risk stratification of patients with KD. 15 , 19 , 20 , 21 , 22 Recent studies have proposed that abnormal findings on initial echocardiography may be associated with resistance to IVIG 15 , 19 in European populations and a baseline coronary artery maximal Z-score ≥ 2.0 in children is predictive of subsequent CAA development in Asian 22 and North American 20 populations.…”

Prediction Model Risk-of-Bias Assessment Tool for coronary artery lesions in Kawasaki disease

“…However, these differences in CAL diagnoses were based on the relevant diagnostic guidelines at that time. Because the Z score was clinically used for a short time, less than half of the articles (7/19) defined CALs by Z score ( 5 , 14 , 16 , 17 , 21 , 24 , 25 ). Four of these articles were published in the last 3 years.…”

“…Thirteen studies used data on patients with KD from different regions of Asia, such as China (20,27,29), Taiwan (16,22,24), Japan (13, 21, 25), Korea (14,26,30), and Thailand (18). Four studies were published in Europe, including Poland (15), Spain (19), Turkey (23) and France (28).…”

“…Almost half of these article outcomes (9/19) to assess the performance of CALs models were sensitivity, specificity, and AUC (area under the curve of a receiver operating characteristic curve). The ranges were as follows: sensitivity, 25.0% (30) to 87.5% (13); specificity, 68.2% (20) to 99% (21); and AUC, 0.52 (30) to 0.86 (24).…”