Predictive risk factors for coronary artery abnormalities in Kawasaki disease

Abstract

Clinical characteristics to predict the development of coronary artery abnormalities (CAA) in Kawasaki disease (KD) were assessed by reviewing medical records of patients diagnosed with KD at Korea University Medical Center from March 2001 to February 2005. Of the 285 patients diagnosed with KD, 19 developed CAA (6.7%). Compared with the CAA(-) group, the CAA(+) group had a longer duration of fever after intravenous gamma-globulin (IVGG) injection (2.4+/-2.9 vs. 1.5+/-1.2 days, p=0.008) and higher C-reactive protein (CRP)(12.3+/-7.8 vs. 8.7+/-7.1 mg/dL, p=0.038). In particular, the CAA(+) group tended to have more than 7 days of fever before IVGG and more than 3 days of fever after IVGG (26.3 vs. 5.3%, p<0.001; 26.3 vs. 6.4%, p=0.002). When the IVGG responsiveness was defined by the presence of defervescence within 3 days after IVGG, IVGG-non-responders showed a higher incidence of CAA (22.7 vs. 5.3%, p=0.002). Non-responders had a longer duration of fever after IVGG (5.5+/-1.9 vs. 1.2+/-0.6 days, p<0.001) and a significantly increased CRP, AST, ALT and total bilirubin. Multivariate regression analysis for CAA showed that the only factor significantly associated with the development of CAA was total fever that lasted for longer than 8 days (OR=4.052, 95% CI=1.151-14.263, p=0.0293). Conclusively, the most important predictor of CAA in KD is total duration of fever longer than 8 days. Early identification of IVGG non-responders and active therapeutic intervention for fever in KD cases might decrease the incidence of CAA.

Incomplete Kawasaki disease in patients younger than 1 year of age: a possible inherent risk factor

“…Since a functional immune system is needed not only to terminate inflammation but also to develop clinical symptoms, the inadequate immune system of young children may explain the high frequency of incomplete presentation in this age group. This is supported by the fact that the CAA(+) and CAA(−) groups in this study did not differ in CRP values, which is not consistent with previous observations of general populations of KD patients [12,14]. Higher white blood cell and alanine aminotransferase level during the acute febrile phase may be associated with the development of CAA (p=0.058, p=0.052, respectively) ( Table 3).…”

“…Of the hematological findings, the CAA(+) group only differed from the CAA(−) group in having significantly higher total white blood cell (19.2±6.0 K/mm 3 vs. 14.7±4.7 K/mm 3 , p=0.007) and platelet (462.9±101.0 K/mm 3 vs. 383.6±121.1 K/mm 3 , p=0.014) levels. The two groups did not differ in C-reactive protein (CRP) levels, which is not consistent with the observations of two other studies examining general populations of KD patients [12,14]. While the CAA(+) group tended to have higher levels of B-type natriuretic peptide (BNP), which is a sensitive but unspecific marker of cardiac structural and functional abnormalities [16], this difference did not attain statistical significance (p=0.276).…”

Complete and incomplete Kawasaki disease: two sides of the same coin

“…Our study defined incomplete KD based solely on clinical signs, without the use of echocardiograms. In our analysis, no differences were found between the incomplete group and the complete group in regards to coronary artery abnormalities both in unadjusted comparisons and in regression models correcting for known risk factors for coronary artery abnormalities [8,13,15,19,22].…”

Responsiveness to intravenous immunoglobulins and occurrence of coronary artery abnormalities in a single-center cohort of Italian patients with Kawasaki syndrome

“…Failure of a single IVIG dose might occur in up to 11.6% of KS patients, especially if displaying low hemoglobin, high neutrophil count and low albumin [15]. In the most recent medical literature it has been accepted that an anticipated identification of IVIG-nonresponders might decrease the overall incidence of CAA through a "most intense" treatment and that the main predictor of CAA occurrence is the overall duration of fever longer than 8 days [16].…”