The Harada Score in the US Population of Children With Kawasaki Disease

Tewelde, H; Yoon, Jeein; Ittersum, Wendy Van; Worley, Sarah; Preminger, Tamar J.; Goldfarb, Johanna

doi:10.1542/hpeds.2014-0008

Cited by 22 publications

(18 citation statements)

References 13 publications

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“…Tremoulet et al described similar findings with the application of the Egami risk score to a cohort from San Diego, California . The Harada risk score has been applied to a US population and was found to be 90% sensitive for identifying children at high risk of CAAs but had low specificity (51%) and low positive predictive value (PPV; 19%) …”

Section: Introductionmentioning

confidence: 72%

Predicting Coronary Artery Aneurysms in Kawasaki Disease at a North American Center: An Assessment of Baseline z Scores

Son

Gauvreau

Kim

et al. 2017

JAHA

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BackgroundAccurate risk prediction of coronary artery aneurysms (CAAs) in North American children with Kawasaki disease remains a clinical challenge. We sought to determine the predictive utility of baseline coronary dimensions adjusted for body surface area (z scores) for future CAAs in Kawasaki disease and explored the extent to which addition of established Japanese risk scores to baseline coronary artery z scores improved discrimination for CAA development.Methods and ResultsWe explored the relationships of CAA with baseline z scores; with Kobayashi, Sano, Egami, and Harada risk scores; and with the combination of baseline z scores and risk scores. We defined CAA as a maximum z score (zMax) ≥2.5 of the left anterior descending or right coronary artery at 4 to 8 weeks of illness. Of 261 patients, 77 patients (29%) had a baseline zMax ≥2.0. CAAs occurred in 15 patients (6%). CAAs were strongly associated with baseline zMax ≥2.0 versus <2.0 (12 [16%] versus 3 [2%], respectively, P<0.001). Baseline zMax ≥2.0 had a C statistic of 0.77, good sensitivity (80%), and excellent negative predictive value (98%). None of the risk scores alone had adequate discrimination. When high‐risk status per the Japanese risk scores was added to models containing baseline zMax ≥2.0, none were significantly better than baseline zMax ≥2.0 alone.ConclusionsIn a North American center, baseline zMax ≥2.0 in children with Kawasaki disease demonstrated high predictive utility for later development of CAA. Future studies should validate the utility of our findings.

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Section: Introductionmentioning

confidence: 72%

Predicting Coronary Artery Aneurysms in Kawasaki Disease at a North American Center: An Assessment of Baseline z Scores

Son

Gauvreau

Kim

et al. 2017

JAHA

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“…Although this score should not be used to triage children who do not need IVIG, its influence was dispelled over time because, nowadays, IVIG is necessarily given to “all” KS patients. In 2014 Tewelde et al [ 10 ] performed a retrospective chart review of 105 patients admitted to the Cleveland Children’s Clinic from 2001 to 2011 whose final diagnosis was KS, and suggested that the Harada score was effective also in the USA population (having a median age at time of diagnosis of 2.8 years), with the aim of selecting high-risk children who might benefit from further evaluation and additional therapies beyond standard IVIG. They also concluded that the score had adequate sensitivity (90%) in the selection of children with higher risk of developing CAA, though low specificity (51%).…”

Section: The Harada Score In Kawasaki Syndromementioning

confidence: 99%

Critical Overview of the Risk Scoring Systems to Predict Non-Responsiveness to Intravenous Immunoglobulin in Kawasaki Syndrome

Rigante

Andreozzi

Fastiggi

et al. 2016

IJMS

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Kawasaki syndrome (KS) is the most relevant cause of heart disease in children living in developed countries. Intravenous immunoglobulin (IVIG) has a preventive function in the formation of coronary artery abnormalities and a poor strictly-curative action in established coronary damage. More than two decades ago, the Harada score was set to assess which children with KS should be subject to administration of IVIG, evaluating retrospectively a large cohort of patients with regard to age, sex and laboratory data. Nowadays, high dose IVIG is administered to all children with a confirmed diagnosis of KS, but a tool for predicting non-responsiveness to the initial infusion of IVIG has not been found. The prediction of IVIG resistance is a crucial issue, as recognising these high-risk patients should consent the administration of an intensified initial treatment in combination with IVIG in order to prevent coronary injuries. Few reports have focused on factors, referring to both clinical parameters and laboratory data at the onset of KS, in order to predict which patients might be IVIG non-responsive. We have analysed three different risk scores which were formulated to predict IVIG resistance in Japanese children with typical KS, but their application in non-Japanese patients or in those with incomplete and atypical patterns of the disease has been studied in a fragmentary way. Overall, our analysis showed that early and definite ascertainment of likely IVIG non-responders who require additional therapies reducing the development of coronary artery involvement in children with KS is still a challenge.

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“…10 Foi posteriormente aplicado nos EUA, mostrando-se eficaz em identificar as crianças de risco elevado que beneficiariam de tratamento adjuvante inicial. 14 -Todos foram desenvolvidos na população japonesa, pelo que poderá ser problemática a sua aplicação em populações maioritariamente caucasianas, atendendo às diferenças na incidência e gravidade que refletem provavelmente variações genéticas e ambientais; -Diferenças na amostra populacional estudada; -Diferentes protocolos de diagnóstico e tratamento usados; -Diferentes definições de doença refratária.…”

Section: Discussionunclassified

“…10 Apesar de terem uma sensibilidade e especificidade aceitáveis na população japonesa, parecem ter menos aplicabilidade na população caucasiana, conforme demonstrado em alguns estudos. [11][12][13][14] Até à data, nenhum preditor suficientemente fidedigno e consistente foi identificado. O objetivo do presente estudo foi identificar possíveis preditores clínicos e/ou analíticos da DK refratária à imunoglobulina, numa amostra de pacientes com DK tratados num hospital de nível II.…”

Section: Introductionunclassified

Preditores clínico-analíticos da doença de Kawasaki refratária à Imunoglobulina endovenosa

Rangel

2018

Acta Pediátrica Port

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Introduction: Intravenous immunoglobulin resistance occurs in 10% to 20% of cases of Kawasaki disease, resulting in a higher risk of coronary artery abnormalities. The objectives of the study were to determine predictive factors of intravenous immunoglobulin-resistant Kawasaki disease. Methods: We performed a retrospective Analytical study of Kawasaki disease patients treated by intravenous immunoglobulin in a northern Portugal hospital between 2006 and 2016. Patients were divided into two groups according to intravenous immunoglobulin response, resistant and non-resistant. Results: The study included 23 patients, 73.9% male gender, median age 19 months, of whom six (26.1%) were considered intravenous immunoglobulin-resistant. The groups did not differ in terms of gender or clinical manifestations. Significant differences were observed for age >4 years (66.7% vs 17.6%; p<0.04), duration of fever at the time of diagnosis and intravenous immunoglobulin administration (5 vs 9 days; p<0.01), lymphocytes at admission (1400 vs 4400 cells/μl, p=0.01), platelets at admission (255 000 vs 432 000 cells/μl, p<0.01), minimum haemoglobin (7.3 vs 9.9 g/dl, p<1) and minimum serum albumin (2.4 vs 3.4 g/dl, p=0.01). Echocardiographic abnormalities occurred in 34.8%

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The Harada Score in the US Population of Children With Kawasaki Disease

Cited by 22 publications

References 13 publications

Predicting Coronary Artery Aneurysms in Kawasaki Disease at a North American Center: An Assessment of Baseline z Scores

Predicting Coronary Artery Aneurysms in Kawasaki Disease at a North American Center: An Assessment of Baseline z Scores

Critical Overview of the Risk Scoring Systems to Predict Non-Responsiveness to Intravenous Immunoglobulin in Kawasaki Syndrome

Preditores clínico-analíticos da doença de Kawasaki refratária à Imunoglobulina endovenosa

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