Risk factors for the occurrence and persistence of coronary aneurysms in Kawasaki disease

AbstractBackgroundOne of the most important complications of Kawasaki disease is the development of giant coronary aneurysms. Risk factors for their development are still not clear.MethodsA retrospective analysis was conducted at the National Institute of Paediatrics in Mexico City, Mexico. It included all patients with a diagnosis of acute Kawasaki disease between August, 1995 and August, 2015. Clinical and laboratory findings, as well as echocardiographic measurements, were recorded. Patients with giant coronary aneurysms (z-score⩾10) were compared with the rest of the patients. A value of p<0.05 was considered statistically significant. Odds ratios and their 95% confidence intervals were calculated to define risk factors.ResultsDuring the study period, 416 patients were diagnosed with Kawasaki disease. Of them, 34 developed giant coronary aneurysms during the acute stage of the disease. In the multivariate analysis, patients younger than 1 year, those with a higher duration of illness at the time of diagnosis, and those who received additional intravenous immunoglobulin showed a significantly higher frequency of giant coronary aneurysms.ConclusionsOne of the main factors associated with the development of giant coronary aneurysms was the delay in the diagnosis of Kawasaki disease. This finding highlights the importance of maintaining a high suspicion of the disease, which would enable an early diagnosis and prompt treatment and decrease the risk for developing giant coronary aneurysms.

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Abstract O.61: Coronary Artery Stenosis Risk and Progression in Kawasaki Disease Patients: Experience at a U.S. Tertiary Pediatric Center

Circulation ◽

10.1161/circ.131.suppl_2.o61 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Alok Patel ◽

Margaret Bruce ◽

Whitney Harrington ◽

Michael Portman

Keyword(s):

Risk Factors ◽

Coronary Artery ◽

Kawasaki Disease ◽

Coronary Artery Stenosis ◽

Care Center ◽

Artery Stenosis ◽

Pediatric Care ◽

Vascular Abnormalities ◽

Coronary Aneurysms ◽

Patients Experience

Objective: Risk and natural progression of coronary artery stenosis in Kawasaki Disease is not well-defined and is a potential cause of long term morbidity, despite treatment with IVIG. We present a novel study at a US tertiary pediatric care center identifying risk factors for stenosis. Methods: We reviewed charts of all children that underwent cardiac catheterization for coronary artery abnormalities from 1998 to January 2014 at a tertiary pediatric care center. All demographic and diagnostic data was recorded including time intervals to echocardiographic changes and catheterization confirmed cases of stenosis. Multivariate survival analysis was used to identify risk factors with stenosis formation as the main outcome measure. Results: Fifty-two children met inclusion criteria and 18 (34.6%) developed stenosis. The highest risk group overall were children under the age of 6 months (HR 3.66, p=0.005) and those with giant coronary aneurysms (GCA). In a subset of only cases of GCA (33), children under the age of six months were at highest risk (HR 2.62, p=0.04). IVIG administration, gender, and ethnicity were statistically insignificant. The majority of individuals with GCA went on to develop stenosis (19/33). The presence of GCA was 100% sensitive for cases of stenosis. Conclusions: This is a novel study in an American population and demonstrates a relatively high incidence of stenosis in children with KD and coronary vascular abnormalities. Overall, a majority of GCA cases progressed into stenosis, with children under the age of 6 months being at highest risk.

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Use of laboratory data to identify risk factors of giant coronary aneurysms due to Kawasaki disease

Pediatrics International ◽

10.1111/j.1442-200x.2004.01840.x ◽

2004 ◽

Vol 46 (1) ◽

pp. 33-38 ◽

Cited By ~ 55

Author(s):

Yosikazu Nakamura ◽

Mayumi Yashiro ◽

Ritei Uehara ◽

Makoto Watanabe ◽

Morihiro Tajimi ◽

...

Keyword(s):

Risk Factors ◽

Kawasaki Disease ◽

Laboratory Data ◽

Coronary Aneurysms

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Kawasaki disease: Review of risk factors for coronary aneurysms

The Journal of Pediatrics ◽

10.1016/s0022-3476(86)80878-2 ◽

1986 ◽

Vol 108 (3) ◽

pp. 388-392 ◽

Cited By ~ 97

Author(s):

Gideon Koren ◽

Sasson Lavi ◽

Vera Rose ◽

Richard Rowe

Keyword(s):

Risk Factors ◽

Kawasaki Disease ◽

Coronary Aneurysms

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Variation in the management of Kawasaki disease

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-317191 ◽

2019 ◽

Vol 105 (10) ◽

pp. 1004-1006 ◽

Cited By ~ 2

Author(s):

Audrey Dionne ◽

David Burgner ◽

Sarah De Ferranti ◽

Davinder Singh-Grewal ◽

Jane Newburger ◽

...

Keyword(s):

Kawasaki Disease ◽

Initial Treatment ◽

Coronary Aneurysm ◽

Medical Specialty ◽

Primary Treatment ◽

Management Options ◽

Necrosis Factor Alpha ◽

Coronary Aneurysms ◽

Factor Alpha ◽

Collaborative Efforts

Intravenous immunoglobulin (IVIG) reduces coronary aneurysms in patients with Kawasaki disease (KD), but additional management options remain challenging, with no generalisable evidence-based recommendations. We performed a survey of 724 physicians from 73 countries to assess variation in practice. IVIG was the preferred initial treatment by 659 (91%) of respondents. Criteria for adjunctive primary treatment varied considerably and definitions of IVIG resistance varied markedly by geographical continent, Human Development Index tiers and medical specialty. A second dose of IVIG was used most often for patients with coronary aneurysm non-responsive to initial treatment (572, 79%), but corticosteroids (379, 52%) and tumour necrosis factor alpha inhibitors (208, 29%) were also frequently used. Our findings highlight the need for international collaborative efforts to optimise management of patients with KD worldwide.

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Exposures associated with the onset of Kawasaki disease in infancy from the Japan Environment and Children’s Study

Scientific Reports ◽

10.1038/s41598-021-92669-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sayaka Fukuda ◽

Shiro Tanaka ◽

Chihiro Kawakami ◽

Tohru Kobayashi ◽

Shuichi Ito ◽

...

Keyword(s):

Risk Factors ◽

Kawasaki Disease ◽

Systemic Vasculitis ◽

First Trimester ◽

Study Data ◽

Causal Effects ◽

Birth Cohort Study ◽

Multivariate Logistic Regression ◽

Maternal Thyroid ◽

Infants And Young Children

AbstractKawasaki disease (KD) is an acute systemic vasculitis that mainly affects infants and young children. The etiology of KD has been discussed for several decades; however, no reproducible risk factors have yet been proven. We used the Japan Environment and Children’s Study data to explore the association between the causal effects of exposure during the fetal and neonatal periods and KD onset. The Japan Environment and Children’s Study, a nationwide birth cohort study, has followed approximately 100,000 children since 2011. We obtained data on exposures and outcomes from the first trimester to 12 months after birth. Finally, we included 90,486 children who were followed for 12 months. Among them, 343 children developed KD. Multivariate logistic regression revealed that insufficient intake of folic acid during pregnancy (odds ratio [OR], 1.37; 95% CI 1.08–1.74), maternal thyroid disease during pregnancy (OR, 2.03; 95% CI 1.04–3.94), and presence of siblings (OR, 1.33; 95% CI 1.06–1.67) were associated with KD onset in infancy. In this study, we identified three exposures as risk factors for KD. Further well-designed studies are needed to confirm a causal relationship between these exposures and KD onset.

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Risk factors for retropharyngeal cellulitis in Kawasaki disease

Auris Nasus Larynx ◽

10.1016/j.anl.2014.05.017 ◽

2014 ◽

Vol 41 (5) ◽

pp. 455-458 ◽

Cited By ~ 16

Author(s):

Risa Tona ◽

Shogo Shinohara ◽

Keizo Fujiwara ◽

Masahiro Kikuchi ◽

Yuji Kanazawa ◽

...

Keyword(s):

Risk Factors ◽

Kawasaki Disease

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Kawasaki disease complicated by cerebral infarction

Cardiology in the Young ◽

10.1017/s1047951103000179 ◽

2003 ◽

Vol 13 (1) ◽

pp. 103-105 ◽

Cited By ~ 14

Author(s):

Kenji Suda ◽

Masahiko Matsumura ◽

Shigeru Ohta

Keyword(s):

Kawasaki Disease ◽

Cerebral Infarction ◽

Clinical Situation ◽

Sudden Onset ◽

X Ray ◽

Coronary Aneurysms ◽

Intracoronary Thrombolysis ◽

Tissue Plasminogen ◽

X Ray Computed ◽

The Right

An 8-month-old boy presented with right hemiplegia of sudden onset after 20 days of Kawasaki disease, which was not initially treated by gamma globulin. Cranial X-ray computed tomography confirmed cerebral infarction as the cause of the right hemiplegia. In subsequent weeks, he developed multiple thromboses in coronary aneurysms. He successfully underwent intracoronary thrombolysis using tissue plasminogen activator without haemorrhagic complications. Cerebral infarction as a complication of Kawasaki disease is rare, and is a difficult clinical situation to manage.

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